LIB  PI -A.  PI  "ST 

PRINCETOK,  X.  J. 

The  Stephen  Collins  Donation, 

_. .    .  — '        II   " 

No.  Case,    ^j/!hl^i 

No.  Shelf,           '.^^ 
J\"o.  Book,                 ;%^  ' 
. ~Tin:r,,       -- 


I 


c 


.™4U   Lemmon-r-^o 


AN 


ACCOUNT 


OF    THE 


Bilious  remitting  and  intermitting 

YELLOW     FEVER, 

AS    IT    APPEARED    IN 

PHILADELPHIA, 

IN  THE  TMAR  1794' 


MED    I   C  A   L 
Inquiries  and  Obfervations : 

CONTAINING 

AN    ACCOUNT 

OF    THE 

Bilious  remitting  and  intermitting 
YELLOW     FEVER, 

AS  /r  APPEARED  IN  PHILADELPHIA  IN  THE  TEAR   1 794. 

TOGETHER    WITH 

A  N     I  N  Q^U  I  R  Y 

INTO    THE ' 

PROXIMATE  CAUSE  OF  FEVER; 

AND 

A  Defence  of  Blood-letting 

AS    A 

REMEDY 

FOR 

CERTAIN    DISEASES. 

•'       By  Benjamin  Rufh,   M.  d. 

PROFESSOR  OF  THE   INSTITUTES,  AND  OF  CLINICAL  MEDICINS, 
IN    THE    UNIVERSITY   OF    PENNSYLVANIA. 


VOLUME     IV. 


PHILADELPHIA; 

PRINTED    BY    THOMAS    DOBSON,     AT    THE    STONE-HOUSi, 

N**    41,    SOUTH    SECOND-STREET. 


1796. 


THE    PREFACE. 


XT  is  common  in  the  Preface  to 
Medical  books  to  extol  fads,  at  the  expence  of 
theory.  Were  I  difpofed  to  confider  the  com^ 
parative  merit  of  each  of  them,  1  fliould  derive 
moft  of  the  evils  of  medicine  from  fuppofed 
fadts,  and  afcribe  all  the  remedies  which  have 
been  uniformly  and  extenfively  ufeful,  to  fuch 
theories  as  are  true.  Fadts  are  combined  and 
rendered  nfefuU  only  by  means  ot  theories  ;  and 
the  more  difpofed  men  are  to  reafon,  the  more 
minute  and  extenfive  they  become  in  their  ob- 
fervations.  Under  the  influence  of  thefe  opi- 
nions, 1  have  ventured  to  deliver,  in  the  follow- 
ing pages,  fome  new  principles  in  medicine.  I 
wifh  it  had  been  convenient  to  have  kept 
them  a  few  years  longer  from  the  public  eye, 
in  order  to  have  improved  them  by  flow  and 
frequent  revifions;  but  the  importunities   of 

b  my 


VI  THE    PREFACE. 

my  pupils,  added  to  a  fenfe  of  the  precarious 
tenure  by  which  I  hold  a  laborious  life,  have 
induced  me  to  publifh  them  in  their  prefent 
concife  and  immature  ftate.  If  they  lead  the 
reader  to  exercife  his  reafon  in  examining 
them  carefully,  he  v^^ill  readily  fupply  my  de- 
ficiency of  time  and  ftudy  in  preparing  them 
for  the  prefs.  He  will  reject  what  is  erro- 
neous in  them,  and  apply  what  is  not  fo,  to 
all  the  difeafes  of  the  human  body. 

The  Account  of  the  Yellow  Fever,  as  it 
appeared  in  Philadelphia  in  1794,  will,  I 
hope,  be  ufeful,  by  bringing  more  fa£ts  to 
light  upon  the  fubjed:  of  its  origin,  and  by 
exhibiting  that  variety  in  the  fymptoms  and 
method  of  cure,  which  is  produced  by  the  dif- 
ference of  feafon  in  all  epidemics* 

In  ftating  the  conduft,  and  oppofmg  the 
opinions  of  my  medical  brethren,  I  have  not 
been  ad;uated  by  the  leaft  unkindnefs  to  any 
one  of  them.  I  lament  being  called  to  this 
painful  duty,  but  it  muft  be  performed  by 
fomebody,  and  in  this  way  only  can  we  dif- 

charge 


THE    PREFACE.  VU 

charge  our  obligations  to  thofe  men  who,  at 
the  expenfe  of  character  and  fortune,  have 
put  us  in  the  peaceable  pofleffion  of  all  our 
knowledge  in  medicine  ;  for,  however  ftrange 
it  may  appear,  I  believe  we  have  not  admitted 
a  ufeful  medical  principle,  or  remedy  of  any 
kind,  but  what  has  coft  the  authors  of  them 
more  or  lefs  conflicts  with  cotemporary  phy- 
ficians. 

If  the  principles  contained  in  this  volume 
fhould  be  received  with  candour,  they  fhall  be 
followed  (life  and  health  permitting)  by  an 
application  of  them  to  the  cure  of  the  gout, 
and  of  the  difeafes  of  the  mind. 

BENJAMIN  RUSH. 

id  July,  1796. 


(^  The  reader  is  defired  to  correal  the  following  mijlakes  ,*— 

In  page  3,  line  14  from  the  top,  for  them^  read  the  earth.  In 
line  the  laft  of  the  fame  page,  for  hct  read  become, 

—  p.  71,  line  12,  infert  the  word  hot^  before  climates. 

—  the  laft  line  of  p.  96,  infert  ivithout  malignant  fy^ptotns^  after 
the  word  intermittent t  and  erafe  the  fame  in  the  firft  line 
of  p.  97. 

—  p.  103,  line  the  8th  from  the  bottom,  infert  though  it  nvas 
performed  fparingly  towards  its  clofe^  after  the  Vf or d  fever. 

—  p.  no,  line  the  3d  from  the  top,  inftead  of  appear  to  have 
thronvn,  m^trl  probably  threw.  In  line  4th,  inftead  oi  and, 
rea-d  for.  And  in  lines  8  and  9,  inftead  of  and  I  thinks 
read  or  perhaps. 

* —  p*  232,  line  14th  from  the  top,  inftead  oi  conneiled  auith, 
read  confined  to. 


CONTENTS. 


A  Page 
CCOUNT  of  the  weather  and  difeafes  which 

preceded  the  yellow  fever  in  1794,              -             -  i 

Names  given  to  it  by  feme  of  the  phyficians  of  the  city,  13 

Conduct  of  the  Committee  of  Health,   and  their  report 

from  an  examination  of  fome  of  the  phyficians,  15 
Reafons  why  the  prevalence  of  the  yellow  fever  in  a  city 

fhould  always  be  made  public,               -                 -  23 

Its  predifpofing  and  exciting  caufes,              -             -  25 

Its  fymptoms,                 .                 -                 _  27 

Its  forms  or  type,                  •                 -                  -  44 

Its  predominance  over  all  other  difeafes,  -  50 
Its  contagious  quality,  and  its  peculiar  effe<5ts  upon  the 

body,  where  it  did  not  excite  fever,               .  -  53 

Methods  of  obviating  the  contagion  of  the  yellow  fever,  56 

Methods  of  preventing  its  fpreading  in  a  city,  -  ^^ 
Difference  in  its   degrees  and  extent  of  contagion,  at 

different  times,  and  in  different  countries,             -  61 

Of  the  origin  of  the  fever  of  1794,             -             -  63 

An  exception  to  the  influence  of  rain  in  checking  it,  67 

Obfervauons 


Vlll  CONTENTS. 

Obfervations  on  the  (late  of  the  atmofphere  which  dif- 

pofes  to  malignant  or  inflammatory  fevers,  75 

The    influence  of  marfii  exhalations  on  the  bodies  of 

certain  domeftic  animals,  -  -  79 

Comparative  view  of  the  relative  contagious  nature, 
diftance  of  infedion,  and  mortality  of  contagious 
fevers,  -  -  -  ,*  80 

Method  of  treating  the  yellow  fever  of  1794,  -         83 

Appearances  of  the  blood,  -  -  -  86 

Comparative  view  of  the  fuccefs  of  the  Philadelphia 
and  Baltimore  methods  of  treating  it,  with  that 
Tk'hich  has  been  common  in  the  Wefl:  Indies,  114 


AN  Inquiry  into  the  Proximate  Cause  of  Fever,  121 

Of  the  fymptoms  of  fever,                 -                 -  141 

Of  the  ftates  of  fever,             -             -                 -  149 

Of  the  nofological  arrangement  of  difeafes,  150 
A  table  of  fevers,  according  to  their  different  degrees 

of  inflammatory  adion,                   .                   *  153 

Of  ftates  of  fever  which  are  general,               *  155 

which  are  general  and  local,  167 

Of  mifplaced  ftates  of  fevers,                -                 -  174 


A  DsFENCE  OF  Blood-letting,             *            •  jS^ 

its  natural  indications,                 ».                   -  J 86 

Its  advantages,                  -                 -                 -  J 88 

The  objeclions  to  it  ftated  and  anfvvered,             -  195 
Comparative  view  of  the  effeds  of  blood-letting,  and 

other  depleting  remedies,                 -               ^  214 

Of 


CONTENTS.  IX 

Of  the   indications  of  blood-letting  from  the  (late  of 

the  pulfe,  -  -  -  223 

from  the  chara(5ler  of  the  reigning  epidemic,  228 

•  from  the  conftitution  of  the  patient,         -  229 

,  from  the  place  from  which  perfons  have  lately 

arrived,  or  in  which  they  have  been  born,  ibidem 

from  the  appearances  of  the  blood,  -  230 


Of  the  quantity  of  blood  which  may  be  drawn  in  in- 
flammatory fever,  -  -  -  234 
Of  the  quantity  which  fliould  be  drawn  at  one  time,  239 
Of  arteriotomy,  -  -  -  -  241 
The  place  from  which  blood  fliould  be  drawn,  242 
Of  cupping,  -  -  -  -  245 
Of  the  time  for  bleeding  in  fevers,  -  ibid. 
The  effefls  of  blood-letting  about  the  celTation  of  men- 

ftruation,                  -              -              -                  -  246 

Of  its  effedts  in  faciHtating  parturition,         -         -  ibid. 

in  hydrophobia,              -               -  247 

.              in  diilocations,                  -                  -  ibid. 

in  certain  difeafes  of  old  people,  248 

Oppofition  to  blood-leiting  in  the  United  Stares,  ibid. 

Its  origin  derived  in  part  from  a  political  caufe,  251 

"General  refle<^ions  and  conclufion,                   -  254 


AN 


ACCOUNT,    &c. 


1  CONCLUDED  the  Hiftory  of  the  fymp« 
toms  of  the  Bilious  Remitting  Yellow  Fever  as 
it  appeared  in  Philadelphia  in  the  year  1793,  by 
taking  notice  that  the  difeafes  which  fucceeded  that 
fatal  epidemic,  were  all  of  a  highly  inflammatory 
nature. 

I  have  formerly  defcribed  the  weather  and  dif- 
eafes of  the  months  of  March  and  April  in  the 
fpring  of  1794. 

The  weather  during  the  firfl:  three  weeks  of  the 
month  of  May  was  dry  and  temperate,  with  now 
and  then  a  cold  day  and  night.  The  ftrawberries 
were  ripe  on  the  15th,  and  cherries  on  the  2 2d 
day  of  the  month  in  feveral  of  the  city  gardens* 

VOL.  IV.  A  A  (liower 


a  AN    ACCOUNT    OF    THE 

A  fliower  of  hail  fell  on  the  afternoon  of  the  2 2d, 
which  broke  the  glafs  windows  of  many  houfes.  A 
Ungle  flone  of  this  hail  was  found  to  weigh  two 
drachms.  Several  people  collected  a  quantity  of  it, 
and  preferved  it  till  the  next  day  in  their  cellars, 
when  they  ufed  it  for  the  purpofe  of  cooling  their 
wine.  The  weather  after  this  hail  florm  was  rainy 
during  the  remaining  part  of  the  month.  The 
difeafes  were  ftill  inflammatory.  Many  perfons  were 
afflifted  with  a  fore  mouth  in  this  month. 

The  weather  in  June  was  pleafant  and  tempe- 
rate. Several  intermittents,  and  two  very  acute 
pleuriiies  occurred  in  my  praflice  during  this  month. 
The  intermittents  were  uncommonly  obllinate,  and 
would  not  yield  to  the  largell  dofes  of  the  bark. 

In  a  fon  of  Mr.  Samuel  Coates  of  feven  years 
old,  the  bark  produced  a  fudden  tranflation  of  this 
ftate  of  fever  to  the  head,  where  it  produced  all  the 
fymptoms  of  the  firfl  ftage  of  internal  dropfy  of 
the  brain.  This  once  formidable  diforder  yielded 
in  this  cafe  to  three  bleedings,  and  other  depleting 
medicines.  The  blood  drawn  in  every  inftance 
was  fizy. 

J'rom  the  inflamjnatory  complexion  of  the  dif- 
eafes of  the  fpring,  and  of  the  beginning  of  June, 

I  cxpe^ed 


BILIOUS    YELLOW    FEVER,    IN    1 794.  3 

I  expelled  the  fevers  of  the  fummer  and  autumn 
would  be  of  a  violent  and  malignant  nature.  I  wa* 
the  more  difpofed  to  entertain  this  opinion  from 
obferving  the  flagnating  filth  of  the  gutters  of  our 
city  ;  for  the  citizens  of  Philadelphia  having  an  in- 
terefl  in  rejecting  the  proofs  of  the  generation  of 
the  epidemic  of  1793  in  their  city,  had  negleci:ed  to 
introduce  the  regulations  which  were  neceffary  to 
prevent  the  producSiion  of  a  fimilar  fever  from  do- 
mefliic  putrefafiion.  They  had,  it  is  true,  taken 
pains  to  remove  the  earth  and  offal  matters  which 
accumulated  in  the  ftreets  ^  but  thefe,  from  their 
being  always  dry,  were  inoffenfive  as  remote  caufes 
of  difeafe.  Perhaps  the  removal  of  them  did  harm, 
by  preventing  the  abforption  of  the  miafmata  which 
were  conftantly  exhaled  from  the  gutters. 

On  the  6th  of  June  Dr.  Phyfick  called  upon 
me,  and  informed  me  that  he  had  a  woman  in  the 
yellow  fever  under  his  care.  The  information  did 
not  furprife  me,  but  it  awakened  fuddenly  in  my 
mind  the  mod  diflreffmg  emotions.  I  advifed  him 
to  inform  the  mayor  of  the  city  of  the  cafe,  but 
by  no  means  to  make  it  more  public,  for  I  hoped 
that  it  might  be  a  fporadic  inflance  of  the  diforder, 
and  that  it  might  not  be  general  in  the  city. 

A  2  On 


4  AN    ACCOUNT    OF    THE 

On  the  1 2th  of  the  month  my  fears  6f  the  re- 
turn of  the  yellow  fever  were  revived  by  vifiting 
Mr.  Ifaac  Morris,  whom  I  fouftd  very  ill  with  a 
violent  puking,  great  pain  in  his  head,  a  red  eyc^ 
and  a  flow  tenfe  pulfe»  I  ordered  him  to  ht  bled, 
and  purged  him  plentifully  with  jalap  and  calomeL 
His  blood  had  that  appearance  which  has  been 
compared  by  authors  to  the  wafliings  of  raw  ilefli 
in  water.  Upon  hk  recovery  he  told  me  that  he 
*^  fufpefted  he  had  had  the  yellow  fever,  for  that 
his  feelings  were  exa£i:ly  fuch  as  they  had  been  in 
the  fall  of  1793,  at  which  time  he  had  an  attack 
of  that  diforder." 

On  the  14th  of  June  I  was  fent  for  in  the  ab- 
fence  of  Dr.  Meafe,  to  vifit  his  filler  in  a  fever.  Her 
mother  who  had  become  intimately  acquainted  with 
the  yellow  fever  by  nurfmg  her  fon  and  mother  in 
it,  the  year  before,  at  once  decided  upon  the  name 
of  her  daughter's  diforder.  Her  fymptoms  were 
violent,  but  they  appeared  in  an  intermitting  form. 
Each  paroxyfm  of  her  fever  was  like  a  hurricane  to 
her  v/hole  fyllem.  It  excited  apprehenfions  of  im- 
mediate diiTolution  in  the  minds  of  all  her  friends^ 
The  lofs  of  fixty  ounces  of  blood  by  five  bleedings, 
copious  dofes  of  calomel  and  jalap,  and  a  large  blif- 
ter  to  her  neck,  foon  vanquiihed  this  malignant  in- 
termittent 


BILIOUS    YELLOW    FEVER,    IN    1794.  5 

termittent,  without  the   aid   of  a  fingle   dofe    of 
bark. 

During  the  remaining  part  of  the  month  I  was 
called  to  feveral  cafes  of  fever  which  had  fymptoms 
of  malignity  of  a  fufpicious  nature.  The  fon  of 
Mr.  Andrew  Brown  had  an  hcemorrhage  from  his 
nofe  in  a  fever,  and  a  cafe  of  menorrhagia  occurred 
in  a  woman  who  was  affefled  with  but  a  flight  de- 
gree of  fever. 

In  the  courfe  of  this  month  I  met  with  feveral 
cafes  of  fwelled  tefticles,  which  had  fucceeded  fevers 
fo  flight  as  to  have  required  no  medical  aid.  Dr. 
Defportes  records  fimilar  inllances  of  a  fwelling  in 
the  teft^icles  which  appeared  during  the  prevalence 
of  the  yellow  fever  in  St.  Domingo  in  the  year 
1741.  * 

In  the  month  of  July  I  viflted  James  Lefferty  and 
William  Adams,  both  of  whom  had,  with  the  ufual 
fymptoms  of  yellow  fever,  a  yellow  colour  on  their 
flcin.  I  likevv^ife  attended  three  women,  in  whom  I 
difcovered  the  difeafe  under  forms  in  which  I  had 
often  (een  it  in  the  year  1793.  In  two  or  them  it 
iippeared  with  fymptoms  of  a  violent  colic,  whicli 

'  Hiiloire  des  Maladies  d-e  Saint  Domingue,  p.  1*2. 

A  3  yielded 


6  ^   AN    ACCOUNT    OF    THE 

yielded  only  to  frequent  bleedings.  In  the  third, 
it  appeared  with  fymptoms  of  preurify,  which  was 
attended  with  a  conflant  haemorrhage  from  the  ute- 
rus, although  blood  was  drawn  almofl  daily  from 
her  arm  for  fix  or  feven  days.  About  the  middle 
of  this  month  many  people  complained  of  a  ficknefs 
at  ftomach,  which  in  fome  cafes  produced  a  puking, 
without  any  fymptoms  of  fever. 

During  the  month  of  Auguft,  I  was  called  to 
Peter  Denham,  Mrs.  Bruce,  a  fon  of  Jacob  Crib- 
ble's, Mr.  Cole,  John  Madge,  Mrs.  Gardiner,  Mifs 
Purdon,  Mrs.  Gavin,  and  Benjamin  Cochran,  each 
of  whom  had  all  the  ufual  fymptoms  of  the  yellow 
fever.  I  found  Mr.  Cochran  fitting  on  the  fide  of 
his  bed,  with  a  pot  in  his  hand,  into  which  he  was 
difcharging  black  bile  from  his  flomach,  on  the  6th 
day  of  the  diforder.  He  died  on  the  next  day. 
Mrs.  Gavin  died  on  the  6th  day  of  her  diforder, 
from  a  want  of  fufficient  bleeding,  to  which  llie  ob- 
je<!led  from  the  influence  of  her  friends.  Befides 
the  above  perfons,  I  vifited  Mr.  George  Eyre  at 
Kenfmgton,  Mr.  Thomas  Fitzfimons,  and  Thomas 
M'Kean,  jun.  fon  of  the  chief  juflice  of  Pennfyl- 
yania,  all  of  whom  had  the  diforder,  but  in  a  mo- 
derate degree.  From  none  of  them  had  1  as  yet 
obferved  the  fever  to  be  propagated  by  contagion, 
?.Vid  therefore  I  took  no  ileps  to  alarm  my  fellow- 
citizens 


BILIOUS   YELLOW   FEVER,   IN    1 794.  7 

citizens  wftb.  the  mrwelcome  news  of  its  being  in 
town.  But  my  mind  was  not  eafy  in  this  fituation, 
for  I  daily  heard  of  perfons  who  died  of  the  difor- 
der,  who  might  probably  have  been  faved  had  they 
applied  early  for  relief,  or  had  a  fufpicion  become 
general  among  all  our  phyficians  of  the  exiflence  of 
the  yellow  fever  in  the  city.  The  colera  infantum 
was  common  during  this,  and  part  of  the  preceding 
month.  It  was  more  obilinate  and  more  fatal  than 
in  common  years. 

On  the  1 2th  of  this  month  a  letter  from  Baltimore 
announced  the  exiflence  of  the  yellow  fever  in  that 
city.  One  of  the  patients  whom  I  vifited  in  this 
month,  in  the  fever,  Mr.  Cole,  brought  the  conta- 
gion of  it  in  his  body  from  that  place. 

On  the  25th  of  the  month  two  members  of  a 
committee  lately  appointed  by  the  government  of 
the  flate,  for  taking  care  of  the  health  of  the  city, 
called  upon  mc  to  know  v/hether  the  yellow  fever 
was  in  town.  I  told  them  it  was,  and  mentioned 
fome  of  the  cafes  that  had  come  under  my  notice  ; 
but  informed  them  at  the  ftime  time,  that  1  had 
fecn  no  cafe  in  which  it  had  been  contagious,  and 
that  in  every  cafe  where  I  had  been  called  early, 
.  and  where  my  prefcriptions  had  been  followed,  the 
dii^?afe  had  yielded  to  medicine. 

A  4  On 


S  AK    ACCOUNT    OF    THl 

On  the  29th  of  the  month,  I  received  an  invita- 
tion to  attend  a  meeting  of  the  Committee  of 
Health,  at  their  office  in  Walnut  Street.  They 
interrogated  me  refpe6ling  the  intelligence  I  had 
given  to  two  of  their  members  on  the  25th.  I  re- 
peated it  to  them,  and  mentioned  the  names  of  all 
the  perfons  I  had  attended  in  the  yellow  fever  fmce 
the  9  th  of  June. 

As  I  confidered  the  filth  of  the  gutters,  and  the 
ftagnating  water  in  the  neighbourhood  of  the  city 
to  be  the  remote  caufes  of  this  fever,  I  advifed  the 
Committee  to  have  them  both  removed,  and  thereby 
to  prevent  the  fpreading  of  the  diforder. 

On  the  firfl  week  in  September  the  difeafe  ap- 
peared to  be  contagious  in  feverai  families,  and  the 
number  of  my  patients  w^as  thereby  daily  multi- 
plied. I  now  confidered  it  as  criminal  to  conceal 
any  longer  the  prevalence  of  the  difeafe  in  our  city, 
or  to  elude  the  inquiries  that  were  diredted  to  me 
by  my  fellow-citizens,  refpec):ing  it.  In  vain  did  I 
"wait  for  the  alarm  to  come  from  another  quarter. 
I  recollected  the  flanders  to  which  I  had  expofed 
myfelf  the  year  before,  by  giving  the  firll  notice  of 
the  prevalence  of  the  fever  in  our  city.  But  I  did 
not  hefitate  in  this  fituation,  to  offer  up  my  reputa- 
tion a  fecQiid  time  as  a  facrifice  for  the  lives  of  my 

fellovv' 


BILIOUS    YELLOW    FEVER,    IN    1 794.  9 

fellow-citizens.  In  order  to  render  the  information 
as  public  as  polTible,  I  addreifed  a  letter  to  the 
mayor  of  the  city  on  the  2d  of  September,  in  which 
I  dated  the  exillence,  and  rgntagious  nature  of 
the  difeafe.  The  contents  of  this  letter,  and  my 
information  to  the  Committee  of  Health  refpe<5ling 
the  yellow  fever,  drew  upon  me  the  following  at- 
tack in  Mr.  Fcnno's  newfpaper. 

For  the  Gazette  of  the  United  States. 

'^  Mr.  Fenno, 

"I  BEG  leave,  through  the  channel  of 
your  paper,  to  enquire  of  the  phyfician  who  re- 
ported to  the  infpeiflors  of  health  lail  Friday,  that 
''  the  yellow  fever  had  again  made  its  appearance 
in  this  city,  but  that  it  was  not  at  prefent  conta- 
gious," what  could  have  induced  him  to  make  fuch 
a  report  ?  No  benefit  can  arife  to  the  public  from 
a  knowledge  of  fuch  a  fa£l:,  admittinq^  it  to  be  as 
ftated ;  but  a  great  deal  of  damage  :  becaufe  fuch 
reports  cannot  fail  of  alarming  and  filling  with 
dread,  the  minds  of  thofe  who  are  not  poiTciTed  of 
the  Do(^or's  fine  difcernment  and  capacity  of  fplit- 
ting  difeafes  into  grades,  fub-grades,  and  femi- 
grades ;  therefore  fuch  a  report  will  not  only  ren- 
der multitudes  uneafy,  and  interrupt  the  ufual  courfe 

of 


lO  AN    ACCOUNT    OF    THE 

of  buHnefs,  but  injure  the  interefl  and  reputation  of 
the  city  in  fever al  other  refpefts. 

"  If  the  difeafe  really  exifled,  it  would  be  com- 
mendable to  found  the  alarm — it  would  be  crimi- 
nal to  be  filent ;  but  if  it  is  not  in  the  city,  or  if 
being  in  the  city,  it  is  not  contagious,  it  is  the 
height  of  cruelty  to  create  ufelefs  terror  and  alarm 
in  the  minds  of  the  citizens. 

*^  But  Mr.  Fenno,  is  it  not  very  extraordinary, 
if  the  difeafe  is  in  the  city,  and  the  phyfician  allu- 
ded to  has  had  twenty-fix  cafes  of  it  fmce  June, 
fhat  it  has  appeared  to  none  of  the  other  phyfi- 
cians,  not  even  to  thofe  who  attend  the  Difpenfary, 
wliich  I  am  aifured  from  the  befl  authority  is  the 
cafe  ? 

*^  A  phyfician  who  has  great  weight  with  the  cre- 
dulous and  ignorant,  has  already  attempted  to  ruin 
the  reputation  of  this  flourifliing  and  delightful 
city,  by  publilhing  an  opinion  that  the  late  pefti- 
lential  fever  was  generated  in  it ;  and  that  its  fitua- 
tion  and  climate  is  favourable  to  the  generation  of. 
the  moil  malignant  maladies.  If  fuch  an  opinion 
was  not  believed  by  every  man  who  knows  the  cha- 
rafter  of  that  phyfician  to  be  a  mere  invention  to 
fupport  a   miltaken  theory,   or  that  it  proceeded 

from 


BILIOUS    YELLOW    FEVER,    IN    1 794.  II 

from  a  rage  for  being  efleemed  the  mofi:  learned 
man  in  the  univcrfe  ;  the  author  would  in  a  few 
years  have  the  divine  fatisfa^flion  of  feeing  this  po- 
pulous and  profperous  city  deferted  by  all  its  opu- 
lent inhabitants,  and  become  a  folitary  waile  where 
he  might  fit  alone,  '  fmiling  ghaftly  o*er  its  ruins, 
and  enjoying  the  fruits  of  his  lingular  opinion.* 

"  If  the  opinion  of  that  phyfician  was  founded 
in  fa£t,  Mr.  Fenno,  fuch  would  be  the  blelTed  con- 
fequence  ;  for  who  that  has  any  regard  for  health 
or  life  would  venture  to  remain  in  a  city  notorious 
for  generating  plagues  which  put  hfe  in  perpetual 
jeopardy  ? 

*'  This,  however,  fortunately  is  not  credited,  and 
the  city,  in  fpite  of  the  reveries  of  philofophers, 
phylicians,  and  conjurers,  will  flourilli  for  ages  yet 
to  come  ;  and  when  all  the  fources  of  ilagnant  w^a- 
ter  in  its  fuburbs  come  to  be  removed  or  corrected,, 
it  will  be  one  of  the  moll  healthy  fituations  in  Ame- 
rica. Open  on  every  fide  to  the  accefs  of  the 
winds — with  a  dry  foil — flreets  favourably  arran- 
ged— the  inhabitants  induflrious,  cleanly,  and  well 
informed — it  cannot  in  the  nature  of  things  be  un- 
healthy. Compare  its  bills  of  mortality  with  thofe 
of  Paris,  London,  Edinburgh,  Vienna,    or  Stocks 

holm. 


lij  AN    ACCOUNT    O^    THE 

holm,  and  you  will  at  once  be  convinced  how  much 
more  healthful  it  is  than  either  of  thofe. 


"  Be  under  no  concern  my  fellow-citizens,  the 
yellow  fever  is  not  in  our  city,  nor  is  it  poffible  for 
it  to  be  generated  in  it,  in  its  prefent  fituation. 

WALTER  qUCERIST," 

On  the  i3tli  of  September  I  wrote  a  fecond  let- 
ter to  the  Committee  of  Health,  in  which  I  de- 
clared the  difeafe  to  be  contagious,  and  urged  them 
to  make  the  information  I  gave  them  public.  My 
reafons  for  this  advice  were  flated  in  the  follow- 
ing words :  ''  It  will  excite  the  citizens  to  apply 
early  for  medical  aid,  and  it  will  produce  in  the 
minds  of  fuch  of  the  phyficians  as  are  unprejudiced, 
nn  early  fufpicion  of  the  prefence  of  the  difeafe,  in 
thofe  cafes  where  it  comes  on  with  its  lefs  obvious 
-iymptoms.^ 


>j 


None  of  thefe  communications  produced  the  ef- 
fect: that  was  intended  by  them.  Dr.  Phyfick  and 
Dr.  Dev/ees  fupported  me  in  my  declaration,  but 
ihtlr  tellimony  did  not  protedl  me  from  the  grolTefl 
calumnies  of  my  fellow-citizens.  One  of  my  friends 
informed   me    tliat  he  had  heard  a  propofal  in  a 

public 


BILIOUS    YELLOW    FEVER,    IN    1 794.  I J 

public  company  to  "  drum  me  out  of  the  city."  A 
charge  of  infanity  which  had  been  made  againft 
me  the  year  before,  was  now  revived,  and  propa- 
gated with  fo  much  confidence,  that  one  of  my 
patients  who  had  believed  it,  exprefled  her  furprife 
at  perceiving  no  deviation  from  my  ordinary  man- 
ner, in  a  fick-room.  Several  of  the  phyficians  of 
the  city  united  in  the  llanders  which  were  thrown 
out  againfl  me  j  and  notwithftanding  they  daily  at- 
tended, or  lofl  patients  in  the  yellow  fever,  they 
denied  that  any  cafes  of  it  had  occurred  in  their 
praftice.  To  thefe  cafes  they  gave  other  names. 
I  fliall  briefly  enumerate  thefe  names,  together 
with  the  opinions  of  fome  of  the  phyficians  refpe<5l- 
ing  the  fever.  This  detail  will  be  ufeful ;  for  by 
expofing  the  danger  and  fatal  confequences  of  error 
and  deception,  we  fhall  prevent  their  being  repeat- 
ed, and  thereby  prepare  the  vv^ay  for  the  more 
ready  and  univerfal  admifilon  of  truth,  upon  the 
fubje£l  of  the  fever.  Thus  ignorance  and  vice  will 
appear,  even  in  the  fcience  of  medicine,  not  to  have 
exifted  in  vain. 

It  was  called, 

1.  A  common  intermittent.  2.  A  bilious  fever. 
3,  An  inflammatory  remitting  fever.  4.  A  putrid 
fever.     5.  A  nervous  fever.     6.   A  dropfy  of  the 

brain. 


14  AN    ACCOUNT    OP    THE 

brain.  7.  A  lethargy.  8.  Pieurify.  9.  Gout. 
10.  Rheumatifm.  11.  Colic.  12.  Dyfentery. 
And  13.  Sore  throat.^ 

It  was  faid  further,  not  to  be  the  yellow  fever 
becaufe  it  was  not  contagious,  and  becaufe  forae 
who  had  died  of  it,  had  not  a  fighing  in  the  be- 
ginning, and  a  black  vomiting  in  the  clofe  of  the 
difeafe.  Even  where  the  black  vomiting  and  yel- 
low ikin  occurred,  they  were  faid  not  to  conftitut^ 
a  yellow  fever,  for  that  thofe  fymptoms  occurred  in 
other  fevers. 

A  further  detail  of  the  names  of  this  fever,  and 
of  the  opinions  of  the  phylicians  will  appear  pre- 
fently  in  their  report  to  the  Committee  of  Health 
on  the  30th  of  September. 

Truth,  it  has  often  been  faid,  is  an  unit,  but 
this  is  not  the  cafe  with  error.  While  the  phy- 
ficians  v/ho  aiTerted  that  the  yellow  fever  was  in 
town,  agreed  in  fixing  the  fame  name  to  every  cafe 
of  it,  the  phyficians  who  propagated  the  contrary 
opinion,  gave  diiferent  names  to  the  fame  fever. 

*  A  fore  throat  fometimes  occurs  as  a  fymptom  of  the  yel- 
low fever.  It  is  taken  notice  of  by  Dr.  Blane  in  his  Hiftory 
of  the  Fever  in  the  Weft  Indies. 

In 


BILIOUS    YELLOW    FEVER,    IK     1 794-  1$ 

In  one  inflance  a  citizen  of  Philadelphia  was  faid 
by  one  of  his  phyficians  to  have  died  of  a  lethargy, 
and  by  another,  of  a  nervous  fever.  To  keep  iip 
the  latter  idea,  his  death  was  announced  in  the 
public  papers,  to  have  occurred  after  an  illnefs  of 
two  weeks. 

I  hope  to  fliew  hereafter,  that  it  is  not  more  im- 
proper to  fay  that  men  are  of  different  fpecies,  be- 
caufe  they  are  tall  and  lliort,  or  becaufe  fome  are 
long,  and  others  iliort  lived,  than  that  fevers  are 
of  different  fpecies,  becaufe  they  vary  in  their  fymp- 
toms  and  duration. 

The  conduct  of  the  Committee  of  Health  was 
not  lefs  improper  that  that  of  the  phyficians.  Thej 
not  only  refufed  to  make  the  exigence  of  the  fever 
in  the  city  public,  but  refufed  to  open  Bufli-hiii 
hofpital  for  the  reception  of  the  poor,  although  that 
convenient  and  fpacious  building  had  been  hired 
by  the  city  for  that  purpofe,  and  fent  feverai  poor 
perfons  to  the  hofpital  at  State  IHand.  This  fitua- 
tion  was  preferred  to  Bulh-hill,  to  prevent  the  citi- 
zens being  alarmed,  and  probably  to  favour  the 
opinion  that  the  difeafe  was  imported.  About  the 
fame  time  they  fent  invitations  to  all  the  phyficians 
in  the  city  (Dr.  Phyfick,  Dr.  Dewees,  and  one  more 
excepted)    to  attend  a  meeting  of   the  Board,  at 

the 


l6  AN    ACCOUNT    OF    THE 

the  City  Hall,  in  order  to  afcertain  the  ftate  of 
the  city.  The  following  publication  was  the  refult 
of  that  meeting. 

HEALTH-OFFICE, 

Port  of  Philadelphiay   \Jl  OBoher,  1794. 

"  The  Board  of  Health,  feeling,  in  common  with 
the  reft  of  their  fellow-citizens,  a  concern  for  the 
intereft  and  fafety  of  the  city,  were  induced  to  make 
a  general  invitation  to  the  Faculty,  to  meet  them 
at  the  City  Hall,  on  Tuefday  the  30th  September, 
in  order  that  from  their  communications  a  juft  ftate 
of  the  health  of  the  city  might  be  obtained.  Ac- 
cordingly, the  following  phyficians  were  pleafed  to 
attend,  viz. 

Dr.  Samuel  Duffield,         Dr.  Kuhn, 

Dr.  Parke,  Dr.  Hodge, 

Dr.  Dunlap,  Dr.  Currie, 

Dr.  Wiftar,  Dr.  Benj.  Duffield. 

Dr.  Porter,  and 

Dr.  Annan,  Dr.  Woodhoufe. 

*'  From  the  whole  of  thefe  gentlemen,  to  the 
queftiox^  of  a  contagious  difeafe  (that  is,  a  difeafe 
which  had  been  communicated  from  one  perfon  to 
another)  exifting  at  this  time,  there  were  anfwers 
in  the  negative. 

±  "It 


BILIOUS    YELLOW    FEVER,    IN     1 794.  I J 

*'  It  was  then  propofed  that  cafes  of  autumnal 
fevers,  which  were  conlidered  dangerous  to  the  pa^^ 
tkntSy  fliould  be  mentioned.     To  this 

"  Dr.  Currie  anfwered,  that  an  aged  female  in  a 
remittent  fever,  and  a  boy  in  the  yellow  fever, 
were  the  only  cafes  apparently  dangerous  under  his 
care. 

"  Dr.  Benjamin  Duffield  has  two  cafes  of  au- 
tumnal remittent  fevers,  dangerous,  without  any 
contagion  annexed  to  it. 

"  Dr.  Parke  has  one  cafe,  confidered  dangerous. 

"  Dr.  Wiftar.     One  cafe  that  may  be  dangerous. 

"  Dr.  Hodge.  Five  cafes  that  probably  will  be- 
come putrid  and  dangerous. 

"  Dr.  Barton,  though  not  prefent,  communicated 
through  a  member  of  the  Board,  that  he  has  no 
cafe  of  a  contagious  nature. 

"  Drs.  Rufli  and  Say,  not  being  prefent,  were  fo 
obliging  as  to  make  their  communications  in  writing, 
which  are  hereto  fubjoined. — From 

VOL.  IV,  2J.  Dr. 


iS  AN    ACCOUNT    or    THE 

"  Dr.  Rufli.  '  Out  of  about  thirty  patients  whom 
I  vifit  daily,  who  are  confined  by  bilious  remitting 
and  intermitting  fevers,  twelve  of  them  have  fevers 
of  the  higheft  or  mofl  inflammatory  degree,  com- 
monly called  yellow  fevers.  All  of  them  are  tend- 
ing to  a  favourable  iiTue,  and  from  the  mode  in 
which  they  have  been  treated,  I  hope  no  contagion 
will  be  generated  by  them.' 

"  From  Dr.  Say.  '  Within  the  compafs  of  my 
pra6lice  there  are  a  number  of  people  labouring 
under  remitting  and  intermitting  fevers :  I  have 
had,  I  have  no  doubt,  feveral  cafes  within  the  ten 
days  pail,  of  the  malignant  fever,  though  at  pre- 
fect I  do  not  know  that  I  have  a  decided  cafe  of 
that  kind.' 

"  The  Board  of  Health,  in  addition  to  the  fore- 
going remark,  that  they  are  not  acquainted  with 
any  cafes  of  a  dangerous  nature,  other  than  has 
been  already  flated — and  upon  the  whole,  cannot 
but  felicitate  their  fellow-citizens,  at  a  time  when 
alarms  and  injurious  reports  have  been  induflrioufly 
circulated  to  the  prejudice  of  the  health  of  the  city, 
that  amongfl  the  practice  of  fuch  a  number  of  phy- 
ficians,  there  is  not  one  cafe  of  a  contagious  nature 
apparent,  and  fo  very  few  who  are  dangeroully  ill. 


The 


BILIOUS    YELLOW    FEVER,    IN     1 794.  I9 

"  The  board  further  ha\^e  the  plcafure  to  inform 
the  citizens  that  although  the  houfe  at  Buili-Hill 
was  prepared  for  the  reception  of  fuch  fick  perfons 
as  were  proper  obje(fl:s  for  that  place  on  the  26th 
of  lalt  month,  there  is  not  now,  nor  has  there  been 
a  lingle  patient  there. 

"  By  order,  and  on  behalf  of  the  Board  of  Health. 

JACOB  MORGAN,  Chairman," 

*'  C^  The  citizens  are  requefled  to  meet  this  evening 
at  6  o'clock^  at  the  City  Hall^  to  take  into  confidera* 
iion  the  alarming  accounts  of  the  progrefs  of  a  conta- 
gious dif order  at  Baltimore^  and  to  devife  proper  mea^ 
fures  toproted  the  citizens  from  the  effects  thereof^* 

The  reader  will  pleafe  to  take  notice,  that  the 
quellion  by  the  Committee,  was  whether  "  a  con- 
tagious difeafe  exiiled  at  this  time  in  the  city." 
Why  was  not  an  inquiry  made  whether  the  yellow 
fever  exfiled  at  that  time  in  the  city  ?  or,  Why  was 
that  fever  dcfignated  by  its  being  contagious,  a 
character  which  by  no  means  belongs  to  it  univer- 
fally,  and  that  does  not  conftitute  its  principal  dan- 
ger ;  for  it  is  well  known  that  in  the  Weft  Indies, 
it  aifedls  fo  feldom  by  contagion,  as  to  furnifli  a 
controverfy  among  Weft  Indian    phyficians,    con- 

B  2  cerninj? 


^O  AN    ACCOUNT    OF    TflE 

cerning  its  contagious  nature  ?  Even  in  the  city  of 
Philadelphia,  it  was  not  uniformly  contagious  in 
1793,  many  having  efcaped  it  who  were  conflant- 
ly  expofed  to  its  contagion.  But  further.  Why, 
Was  there  no  retrofpeci:  in  the  inquiry  into  the  (late 
of  the  city,  during  the  weeks  or  months  that  had 
preceded  the  30th  of  September?  Two  of  the 
phyficians  who  afferted  that  they  then  had  no  cafes 
of  yellow  fever  under  their  care,  had  acknowledg- 
ed that  they  had  had  feveral  cafes  of  it  a  few  weeks 
before.  It  is  impoffible  to  review  this  report,, 
without  blufliing  for  the  fliameful  fubmiiTion  made 
by  the  fcience  of  medicine,  to  the  commercial  fpirit 
of  the  city. 

But  let  not  the  reader  complain  of  the  phylician? 
and  citizens  of  Philadelphia  alone.  A  fimilar  con- 
du£i:  has  exifled  in  all  cities,  upon  the  appearance 
of  great  and  mortal  epidemks* 

It  prevailed  lately  in  Algiers,  where  the  Dey 
refufed  to  let  fome  American  prifoners  leave  a  town 
infe^led  by  the  plague,  denying  the  exiftence  of 
the  diforder  in  that  place.*  SuccelTive  attempts  by 
numerous  publications,  were  made  to  conceal  the 
prevalence  of  the  yellow  fever  in  the  cities  of  New 

*  See  Col.  Humphries*s  letter  to  the  citizens  of  the  United 

States,  dated  Lifbon,  July  11,  1794. 

Yorkj 


BILIOUS    YELLOW    FEVER,    IN    1 794.  21 

York,  Baltimore  and  Charlefton,  for  two  years 
pail:.  Such  was  this  felfifli  difpofition  in  the  Com- 
mittee of  Health  in  New  York  in  the  year  1795, 
that  they  wrote  to  the  Committee  of  Health  in  Phi- 
ladelphia, to  deliver  up  the  names  of  feveral  per- 
fons  who  had  in  private  letters  to  their  friends, 
which  had  been  publiflied,  aiTerted  that  the  yellow 
fever  prevailed  in  that  city.  But  the  contradled 
fpirit  of  this  Committee  did  not  end  here.  After 
they  were  compelled  to  acknowledge  the  prevalence 
of  the  fever  among  them,  they  endeavoured  to 
compofe  the  fears  of  their  fellow  citizens,  by  in- 
forming them,  that  a  "  large  proportion  of  the 
deaths  hitherto  reported,  had  fallen  among  emi- 
grants lately  from  Europe,  flrangers,  and  other 
tranfient  perfons,'^t  thereby  intimating,  that  the 
obligations  to  fympathy  fhould  be  confined  wholly 
to  permanent  and  wealthy  citizens. 

Nor  is  it  any  thing  new  for  mortal  difeafes  to  re- 
ceive mild  and  harmlefs  names  from  phyficians. 
The  plague  was  called  a  fpotted  fever  for  feveral 
months,  by  fome  of  the  phyficians  of  London  in  the 
year  1665. 

f  Report  of  the  Committee  of  Health  of  New  York,  dated 
Friday  evening,  September  18,  1795. 

B  3  Added 


22  AN    ACCOUNT    OF    THE 

Added  to  that  fervility  to  wealth,  which  difpofes 
phyficians  to  deny  the  exiftence  of  peftilential  fever? 
in  cities,  there  were  two  other  reafons  which  led  fome 
of  the  phyficians  of  Philadelphia,  to  deny  the  pre- 
valence of  the  yellow  fever  in  our  city  ;  thefe  reafons 
were;  firfl.  The  change  which  they  had  made  in  their 
practice,  for  they  had  adopted  the  depleting  fyftem 
in  a  certain  degree  ;  but  they  declared  that  they  ufed 
it  not  in  the  yellow  fever,  but  in  an  inflammatory 
bilious  remittent ;  and  fecondly,  Their  inability  to 
derive  the  difeafe  from  importation.  To  have  ac- 
knowledged the  exiflence  of  the  difeafe  in  our  city, 
therefore,  would  have  been  a  direli6i:ion  of  two  of 
the  principal   errors    held    by   them  in    the    year 

1793- 

Thus  while  nurfes,  bleeders,  clergymen  and  oc- 
cafional  vifitors  of  the  fick,  and  in  fome  inftances, 
the  fick  themfelves,  united  in  deciding  upon  the  cha- 
racter and  name  of  our  fever,  a  majority  of  the 
phyficians  united  in  perfuading  the  citizens  that  it 
exifled  only  in  the  imaginations  of  two  or  three 
men. 

From  a  review  of  the  conduct  of  cities  upon  the 
fubjeCl  of  difeafes,  an  important  inference  may  be 
made  j  and  that  is,  to  confider  their  public  reports  in 

favour 


BILIOUS    YELLOW    FEVER,    IN    1 794.  23 

favour  of  the  health   of  their  inliabitants,  as  the 
precurfors  of  great  and  mortal  epidemics. 

It  has  been  alked,  why  I  am  more  anxious  to  have 
the  exiilence  of  the  yellow  fever  believed,  than  any 
of  the  other  phyficians  of  the  city  ;  and  why  I  did 
not  cure  it,  without  calling  it  by  its  unpopular 
name  ?  To  this  I  anfwer,  that  I  confider  the  making 
the  difeafe  public,  as  foon  as  it  appears  in  a  city, 
and  the  calling  it  by  its  common  and  vulgar  name, 
to  be  a  duty,  indire^lly  included  in  that  divine  pre- 
cept which  forbids  the  taking  away  a  human  life. 
Dr.  Sydenham  acknowledges  that  he  generally  lofl 
the  firil  four  or  five  patients  he  met  with  in  a  new 
difeafe,  and  all  candid  phyficians  mud  confefs  the 
want  of  the  fame  fuccefs  in  the  beginning,  that 
they  have  in  the  clofe  of  a  new  epidemic.  Now  this 
want  of  fuccefs  may  at  all  times  be  prevented  from 
becoming  general,  by  notice  being  given  of  the 
exiflence  of  a  new  difeafe  as  foon  as  it  makes  its 
appearance.  The  propagation  of  the  difeafe  when 
contagious,  may  moreover  be  checked,  or  its  malig- 
nity mitigated,  by  means  of  diet,  or  medicine, 
when  its  prevalence  is  generally  known,  and  thereby 
many  thoufand  lives  may  be  faved.  There  was 
once  a  law  in  Pennfylvania,  which  puniihed  the 
concealment  of  a  malignant  and  contagious  difeafe 
m  the  city  of  Philadelphia.     Such  a  law  would  be  a 

B  4  bleifing 


24  AN    ACCOUNT    OF    THE 

bleiTing    In   every  country.      Whole    communities 
might  be  faved  by  it. 

Notwithftanding  the  pains  which  were  taken  to 
difcredit  the  report  of  the  exiflcnce  of  the  yellow 
fever  in  the  city,  it  was  finally  believed  by  many 
citizens,  and  a  number  of  families  in  confequence 
of  it,  left  the  city.  And  in  fpite  of  the  harmlcfs 
names  of  intermitting  and  remitting  fever,  and  the 
like,  which  were  given  to  the  diforder,  the  bodies 
of  perfons  who  had  died  with  it,  were  conveyed 
to  the  grave  in  feveral  inflances  upon  a  hearfe, 
the  way  in  which  thofe  who  died  of  the  yellow  fever 
were  buried  the  year  before. 

From  the  influence  of  occafional  fliowers  of  rain, 
in  the  months  of  September  and  October,  the  difeafe 
was  frequently  checked,  fo  as  to  difappear  alto- 
gether for  two  or  three  days  in  my  circle  of  pra61ice. 
It  was  obferved  that  while  fliowers  of  rain  checked 
it,  moiil  or  damp  weather  without  rain,  favoured 
its  propagation.  It  was  further  kept  from  becoming 
general  by  the  mode  of  treating  it ;  for  nearly  all 
the  phyficians  purged,  and  bled  more  or  lefs,  in 
every  cafe  of  fever  they  were  called  to,  by  which 
means  the  produ£tion  of  a  large  mafs  of  contagion, 
was  prevented.  This  peculiarity  in  the  practice  of 
the  oppofmg  phyficians,  did  not  efcape  the  notice 


BILIOUS    YELLOW    FEVER,    IN     1 794.  25 

of  feveral  of  the  reflc^ling  citizens  of  Philadelphia, 
who  remarked  very  properly,  that  two  or  three 
bleedings,  and  purges  of  calomel  and  jalap  were  not 
the  ufual  remedies  for  intermitting  and  remitting  fe- 
vers of  common  years. 

The  cold  weather  In  0(^ober  checked  the  fever, 
but  it  did  not  banilli  it  from  the  city.  It  appeared 
in  November,  and  in  all  the  fucceeding  winter  and 
fpring  months.  The  weather  during  thefe  months 
being  uncommonly  moderate,  will  account  for  its 
not  being  deflroyed  at  the  time  in  which  the  difeafe 
ufually  difappeared  in  former  years. 

The  caufes  which  predifpofed  to  this  fever  were 
the  fame  as  in  the  year  1793.  Perfons  of  full  ha- 
bits, (Irangers,  and  negroes  were  moil  fubje£i:  to  it. 
It  may  feem  flrange  to  thofe  perfons  who  have  read 
that  the  negroes  are  feldom  alfe^led  with  this  fever 
in  the  Weil  Indies,  that  they  were  fo  much  affected 
by  it  in  Philadelphia.  There  were  two  reafons  for 
it.  Their  manner  of  living  was  as  plentiful  as  that 
of  white  people  in  the  Weft  Indies,  and  they  gene- 
rally refided  in  alleys  and  on  the  fivirts  of  the  city, 
where  they  were  more  expofed  to  noxious  exhala- 
tion, than  in  its  more  open  and  central  parts. 

The  fummer  fruits,  from  being  eaten  before  they 
were  ripe,  or  in  too  large  a  quantity,  became  fre- 
quently 


'26  AN    ACCOUNT    OF    THE 

queiitly  exciting  caufes  of  this  fever.  It  was  awa- 
Icened  in  one  of  my  patients  by  a  flipper  of  peaches 
and  milk.  Cucumbers  in  feveral  inftances  gave  vi- 
gor to  the  miafmata  which  had  been  previoufly  re- 
ceived into  the  fydem.  Terror  excited  it  in  tv^^o  of 
my  patients*      In  one  of  them,   a  young  v^^oman, 

this  terror  was  produced  by  hearing,,  while  flie  fat 
at  dinner,  that  a  hearfe  had  pafTed  by  her  door  with 
a  perfon  on  it  who  had  died  of  the  yellow  fever. 
Vexation  excited  it  in  a  foreign  mafler  of  a  veffel 
in  confequence  of  a  young  woman  fuddenly  break- 
ing an  engagement  to  marry  him.  The  difeafe  ter- 
minated fatally  in  this  inflance. 

It  was  fometimes  unfortunate  for  patients  when 
the  difeafe  was  excited  by  an  article  of  diet,  or  by 
any  other  caufe  which  acled  fuddenly  upon  the  fyf- 
tem ;  for  it  led  both  them.,  and  in  fome  inflances 
their  phyficians,  to  confound  thofe  exciting  caufes 
with  its  remote  caufe,  and  to  view  the  difeafe  with- 
out the  leafl  relation  to  the  prevailing  epidemic.  It 
was  from  this  millake  that  many  perfons  were  faid 
to  die  of  intemperance,  of  eating  ice  creams,  and 
of  trifling  colds,  who  certainly  died  of  the  yellow 
fever.  The  rum,  the  ice  creams,  and  the  changes 
in  the  air,  in  all  thefe  cafes  afted  like  fparks 
of  fire  v/hich  fet  in  motion  the  quiefcent  particles 
of  tinder  or  gunpowder. 

Ifhall 


BILIOUS    YELLOW    FEVER,    IN     1 794.  2/ 

I  (liall  now  proceed  to  defcribe  the  fymptoms 
which  this  fever  afuimed  during  the  periods  which 
have  been  mentioned.  This  detail  will  be  interefl- 
ing  to  pliyficians  who  wifli  to  fee  how  little  nature 
regards  the  nofological  arrangement  of  authors  in 
the  formation  of  the  fymptoms  of  difeafes,  and  how 
much  the  feafons  influence  epidemics.  A  phyfician 
who  had  orafticed  medicine  near  fixty  years  in  the 
city  of  Philadelphia,  declared  that  he  had  never  feen 
the  dyfentery  alTume  the  fame  fymptoms  in  any  two 
fuccejjivc  years.  The  fame  may  be  faid  probably 
of  nearly  all  epidemic  difeafes. 

In  the  arrangement  of  the  fymptoms  of  this  fever, 
I  fhall  follow  the  order  I  adopted  in  my  Account 
of  the  Yellow  Fever  of  1793,  and  defcribe  them. 
as  they  appeared  in  the  fanguiferous  fyflem — the 
liver,  lungs,  and  brain — the  alimentary  canal — the 
fecretions  and  excretions — the  nervous  fyflem — the 
fenfes  and  appetites — upon  the  fkin,  and  in  the  blood. 

Two  premonitory  fymptoms  llruck  me  this  year 
which  I  did  not  obferve  in  1793.  One  of  them 
was  a  frequent  difcharge  of  pale  urine  for  a  day 
or  two  before  the  commencement  of  the  fever  ;  the 
other  was  fleep  unufually  found,  the  night  before  the 
attack  of  the  fever.  The  former  fymptom  was  a  pre- 
curfor  of  the  plague  of  Baffora  in  the  year  1773. 

I.  I 


^S  AN    ACCOUNT    OF    THE 

I.  I  obferved  but  few  fymptoms  in  the  fanguife- 
raus  fyftem  dilTerent  from  what  I  have  mentioned 
in  the  fever  of  the  preceding  year*  The  (low  and 
intcnnitting  pulfe  occurred  in  many,  and  a  pulfe 
nearly  imperceptible,  in  three  inftances.  It  was  fel- 
dom  very  frequent.  In  John  Madge,  an  Englifli 
fai-mer  who  had  jufl  arrived  in  our  city,  it  beat  only 
64  flrokes  in  a  minute  for  feveral  days,  while 
jhe  was  fo  ill  as  to  require  three  bleedings  a-day, 
and  at  no  time  of  his  fever  did  his  pulfe  exceed 
96  flrokes  in  a  minute.  In  Mifs  Sally  Eyre  the 
pulfe  at  one  time  was  at  176,  and  at  another  time 
it  was  at  1 40 ;  but  this  frequency  of  pulfe  was 
very  rare.  In  a  majority  of  the  cafes  which  came 
Under  my  notice,  where  the  danger  was  great,  it 
feldom  exceeded  80  ftrokes  in  a  minute.  I  have 
been  thus  particular  in  defcribing  the  frequency  of 
the  pulfe,  becaufe  cuilom  has  created  an  expectation 
of  that  part  of  the  hiflory  of  fevers ;  but  my  at- 
tention was  direCled  chiefly  to  the  different  degrees 
of  force  in  the  pulfe  as  manifefled  by  its  tenfion, 
fulnefs,  intermifTions,  and  inequality  of  aftion.  The 
hobbling  pulfe  was  common.  In  John  Geraud,  I 
perceived  a  quick  flroke  to  fucceed  every  two 
ftrokes  of  an  ordinary  healthy  pulfe.  The  inter- 
mitting and  deprelTed  pulfe  occurred  in  many  cafes. 
I  called  it  the  year  before  2.fidky  pulfe.  One  of  my 
pupils,  Mr.  Alexander,  called  it  more  properly  a 

locked 


BILIOUS    YELLOW    FEVER,    IN    1794.  ^29 

iocked  piilfe.  I  think  I  obferved  this  Hate  of  the 
pulfe  to  occur  chiefly  in  perfons  in  whom  the  fever 
came  on  without  a  chilly  fit.  ^ 

Hcemorrhages  occurred  in  all  the  grades  of  this 
fever,  but  lefs  frequently  in  my  practice  this  year 
than  in  the  year  before.  It  occurred  after  a  ninth 
bleeding  in  Mifs  Sally  Eyre  from  the  nofe  and  bowels. 
It  occurred  from  the  nofe  after  a  fixth  bleeding  in 
Mrs.  Gardiner,  who  was  at  that  time  in  the  fixtk 
month  of  her  pregnancy.  This  fymptom,  which 
was  accompanied  by  a  tenfe  and  quick  pulfe,  in- 
duced me  to  repeat  the  bleeding  a  feventh  time. 
The  blood  was  very  fizy.  I  mention  this  fa^  to 
eflabliih  the  opinion  that  haemorrhages  depend  upon 
too  much  a£lion  in  the  blood-veifels,  and  that  they 
are  not  occafioned  by  a  diilblved  idate  of  the  blood. 

There  was  a  difpofition  at  this  time  to  hcemor- 
rhage  in  perfons  who  were  in  apparent  good  health. 
A  private  in  a  company  of  volunteers  commanded 
by  Major  M'Pherfon,  informed  me  that  three  of 
his  meifmates  were  affe(5led  by  a  bleeding  at  the 
nofe  for  feveral  days  after  they  left  the  city  on  their 
way  to  quell  the  infurre£lion  in  the  weflern  coun- 
ties of  Pennfylvania. 

11.  The  liver  did  not  exhibit  the  ufual  marks 
of  inflammation.     Perhaps  my  mode  of  treating  the 

fever 


^O  AN    ACCOUNT    OP    THE 

fever  prevented  thofe  fymptoms  of  hepatic  affet- 
tioii  which  belong  to  the  yellow  fever  in  tropical 
climates.  The  lungs  were  frequently  aife(Sl:ed  ;  and 
hence  the  difeafe  was  in  many  inflances  called  a 
pleurify  or  a  catarrh.  This  inflammation  of  the 
hmgs  occurred  in  a  more  efpecial  manner  in  the 
winter  feafon.  It  was  diiringuillied  from  the  pleu- 
riiics  of  common  years  by  a  red  eye  ;  by  a  vomit- 
ing of  green  or  yellow  bile  ;  by  black  flools  ;  and 
by  requiring  very  copious  blood-letting  to  cure  it. 

The  head  was  affected  in  this  fever,  not  only 
with  com.a  and  delirium,  but  with  mania.  This 
fymptom  v/as  fo  comm^on  as  to  give  rife  to  an  opi- 
nion that  madnefs  w^as  epidemic  in  our  city.  I  faw 
no  cafe  of  it  which  was  not  connedled  with  other 
fymptoms  of  the  bilious  rem.itting  fever.  The  Rev, 
Mr.  Keating,  one  of  the  minifters  of  the  Roman 
church,  informed  me  that  he  had  been  called  to 
viiit  feven  deranged  perfons  in  his  congregation  in 
the  courfe  of  one  week,  in  the  month  of  March. 
Two  of  them  had  made  attempts  upon  their  lives. 
This  mania  was  probably,  in  each  of  the  above 
cai'cs,  a  fymptom  only  of  general  fever.  The  dila- 
tation of  the  pupil  was  univerfal  in  this  fever. 

Sore  eyes  were  common  during  the  prevalence 
of  this  fever.  In  Mrs.  Learning  this  affection  of 
the  eyes  was  attended  with  a  fever  of  a  tertian  type. 

III.  The 


BILIOUS    YELLOW    FEVER,    IN     1 794-  Jl 

III.  The  alimentary  canal  fulFered  as  ufual  in 
this  fever.  A  vomiting  was  common  upon  tlie 
firfh  attack  of  the  diforder.  I  obferved  this  fymp- 
tom  to  be  lefs  common  after  the  cold  and  rainy 
weather  which  took  place  about  the  firfl  of  Oc- 
tober. 

I  have  in  another  place  mentioned  the  influence 
of  the  weather  upon  the  fymptoms  of  this  difeafe. 
In  addition  to  the  fafis  which  have  been  formerly 
recorded,  I  fliall  add  one  more  from  Dr.  Defportes* 
He  tells  us,  that  in  dry  weather  the  difeafe  affects 
the  head,  and  that  the  bowels  in  this  cafe  are 
more  obftinately  coflive  than  in  moifl  weather. 
This  influence  of  the  atmofphere  on  the  yellow 
fever  will  not  furprife  thofe  phyficians  who  recoiled 
the  remarkable  paffage  in  Hippocrates  in  which 
he  fays,  that  in  the  violent  heats  of  fummer,  fevers 
appeared,  but  without  any  fweat ;  but  if  a  ftiowcr, 
though  ever  fo  flight,  appeared,  a  fweat  broke 
out  in  the  beginning.  *  I  obferved  further,  that 
a  vomiting  rarely  attended  thofe  cafes  in  which 
there  was  an  abfence  of  a  chilly  fit  in  the  begin- 
ning of  the  fever.  The  fame  obfervation  is  made 
by  Dr.  Defportes.  t 

*  Epidemics,  Book  XL  Se6l.  i. 

t  Les  Maladies  de  St.  Domingue,  Vol.  I.  p.  193. 

The 


3 2  i\N    ACCOUNT    Oh'     I'lilL 

The  matter  difcharged  by  vomiting  was  green 
or  yellow  bile  in  mod  cafes.  Mrs.  Jones,  the 
wife  of  Captain  Lloyd  Jones,  and  one  other  per- 
fon,  difcharged  black  bile  within  one  hour  after 
they  were  attacked  by  the  fever.  I  have  taken 
notice  in  the  fecond  edition  of  my  Account  of  the 
Yellow  Fever,  that  a  difcharge  of  bile  in  the  be- 
ginnii,ig  of  this  fever  was  always  a  favourable 
fymptom.  Dr.  Davidfon  of  St.  Vincents,  in  a  let- 
ter to  me,  dated  the  2  2d  July  1794,  makes  the 
fame  remark.  It  fliev/s  that  the  biliary  ducfts  are 
open  J  and  that  the  bile  is  not  in  that  vifcid  and 
impa£i:ed  ftate  which  is  defcribed  in  the  difl'e^tions 
vt  Dr.  Mitchel.  A  diftreffiDg  pain  in  the  fto- 
mach,  called  by  Dr.  Cullen  gaiirodynia,  attended 
in  two  inftanccG.  A  burning  pain  in  the  fcomach, 
and  a  forenefs  to  tlie  touch  of  its  whole  external 
.region,  occurred  in  three  or  four  cafes.  Two  of 
ilicni  were  in  March  1795.  In  MrSo  Vogles,  who 
■had  the  fever  in  September  1794,  the  fenfibility 
of  tlie  pit  of  the  flomach  w'as  fo  exquilite,  that 
fhe  could  not  bear  the  weight  of  a  flieet  upon  it. 

Pains  in  the  bovvxls  were  very  comm.on.  They 
formed  the  true  bilious  colic,  fo  often  mentioned 
l)y  \Vc(l  India  writers.  In  John  Madge  thefe  pains 
produced  a  hardneis  and  contraction  of  the  whole 
..-.xternal  region  of  the  bowels.  They  were  pt -"o- 
I  dical 


DlLIOUS    YELLOW    FEVER,    IN     1 794.  33 

dical  in   Mifs  Nancy  Eyre,  and  in  Mrs  Gardiner, 
and  in  both  cafes  were  attended  with  diarrhoea. 

* 
CosTivENEss   without  pain    was  common,  and 
in  fome  cafes  fo  extremely  obflinate  as  to  refifh  for 
feveral  days  the  fucceffive    and    alternated    ufe  of 
all  the  ufual  purges  of  the  fliops. 

Flatulency  was  Icfs  common  in  this  fever  tha.n  in 
the  year  1793* 

The  difeafe  appeared  with  fymptoms  of  dyfentery 
in  feveral  cafes. 

IV.  The  following  is  an  account  of  the  flate  of 
the  Secretions  and  Excretions  in  this  fever. 

A  puking  of  bile  was  more  common  this  year^ 
than  in  year  1793.  It  was  generally,  of  a  green 
or  yellow  colour.  I  have  remarked  before,  that  two 
of  my  patients  difcharged  black  bile  within  an  hour 
after  they  were  aiie^led  by  the  fever,  and  many 
difcharged  that  kind  of  matter  which  has  been 
Compared  to  coffee  grounds,  towards  the  clofe  o£ 
the  difeafe. 

The  fseces  were  black,  in  mofl:  cafes  where  the 

fymptoms  of  the  higheft  grade  of  the  fever  attend- 

VOL.  IV,  e  ed" 


24  AN    ACCOUNT    OF    THE 

ed.  In  one  very  malignant  cafe,  the  mofl  draflic 
purges  brought  away  by  fifty  evacuations,  nothing 
but  natural  flools.  The  purges  were  continued, 
and  finally  black  fceces  were  difcharged  which  pro- 
duced immediate  relief.  In  one  perfon,  the  fcTces 
were  of  a  light  colour.  In  this  patient  the  yellow- 
nefs  in  the  face  was  of  an  orange  colour,  and  con- 
tinued fo  for  feveral  weeks  after  his  recovery. 

The  urine  was  in  mofl:  cafes  high  coloured.  It 
was  fcanty  in  quantity  in  Peter  Brown,  and  totally 
fuppreffed  in  John  Madge  for  two  days.  I  afcribed 
this  defect  of  natural  adlion  in  the  kidneys,  to  an 
engorgement  in  their  blood  vefiels,  fimilar  to  that 
which  takes  place  in  the  lungs  and  brain  in  this 
fever.  I  had  for  fome  time  entertained  this  idea 
of  a  morbid  afte<9:ion  of  the  kidneys,  but  I  have 
lately  been  confirmed  in  it  by  the  account  which 
Dr.  Chilliolm  gives  of  the  flate  of  one  of  the 
kidneys  in  a  man  whom  he  lofl  with  the  Beul- 
1am  fever  at  Grenada.  "  The  right  kidney  (fays 
the  Po6tor)  was  mortified,  although  during  his  ill- 
nefs  no  fymptom  of  inflammation  of  that  organ  was 
p^ceived."  *  It  would  feem  as  if  the  want  of 
a£l:ion  in  the  kidneys,  and  a  defeft  in  their  functions 

*  EiTiy  on  the  Malignant  Peftilentlal  Fever  introduced  Into 
tbe  Weft  Indies  from  BeuUam,  p.  137. 

were 


BILIOlJS    YELLOW    FEVER,    IN    1794.  ^^^ 

Were  not  necefliirily  attended  with  pain.     I  recollecfi: 
to  have  met  with  feveral  cafes  in   1793,  in  which 
there  was  a  total  abfence  of  pain  in  a  fuppreflion 
of  urine,  of  feveral  days'  continuance.     The  fame 
obfervation   is  made  by  Dr.   Chiiholm,  in  his  ac- 
count of  the  Beullam  fever  of  Grenada.  *     From 
this    facft    it  feems  probable,  that  pain  is  not  the 
effeifl:  of  any  determinate    ftate    of  animal    fibres, 
but  requires  the  concurrence  of   morbid,    or  pre- 
ternatural excitement  to  produce  it.    I  met  with  but 
one  cafe  of  ftrangury  in  this  fever.     It  terminated 
favourably  in  a  few  days.     I  have  never  feen  death 
in    a  fmgle  inftance  in  a    fever    from    any    caufe, 
where  a    flrangury    attended,    and  I   do    not    re- 
collect ever  to  have  feen  a  fatal    ifTue  to  a  fever 
where  this  fymptom  was  accidentally  produced  by . 
a  blifler.     From  this  faft  there  would  feem  to  be 
a  connection  between  a  morbid  excitement  in  the 
neck  of  the  bladder,  and  the  fafety  of  more  vital 
parts  of  the  body.     The    idea  of  this  connection 
was  firfl    fuggeiled  to  me    four-and-twenty    years 
ago,  by  the  late  Dr.  James  Leiper  of  Maryland,  . 
who  informed  me  that  he  had  fometimes  cured  the 
mod  dangerous  cafes  of  pleurify  after  the  ufual  r-e-^  . 
medies    had    failed,  by  exciting    a    flrangury    by 
means  of  the  tinfture  of  Spanilli  flies,  mixed  with^ 
camphorated  fpirit  of  wine* 

*  P.  224, 

G  2.  The- 


^,6  AN    ACCOUNT    OF    THE 

The  tongue  was  always  moifl  in  the  beghming  of 
the  fever,  but  it  was  generally  of  a  darker  colour  than 
lad  year.  When  the  difeafe  was  left  to  itfelf,  or 
treated  with  bark  and  wine,  the  tongue  became  of 
a  fiery  red  colour  or  dry  and  furrowed,  as  in  tjie 
typhus  fever. 

Sweats  were  more  common  in  the  remiffions  of 
this  fever,  than  they  v/ere  in  the  year  1793,  but 
they  feldom  terminated  the  difeafe.  During  the 
courfe  of  the  fweats,  I  obferved  a  deadly  coldnefs 
over  the  whole  body  to  continue  in  feveral  in- 
ilances,  but  without  any  danger  or  inconvenience 
to  the  patient.  In  two  of  the  Vv^orll  cafes  I  at- 
tended, there  were  remiilions,  but  no  fweats  un- 
til the  day  on  v/hich  the  fever  terminated.  In 
feveral  of  my  patients  the  fever  wore  away  with- 
out the  lead  mioiflure  on  the  Pidn,  The  ??iilk  in  one 
cafe  was  of  a  greenidi  colour,  fuch  as  fometimes  appears 
in  the  ferum  of  the  blood.  In  another  female  pa- 
'tlent  who  gave  fuck,  there  was  no  diminution  in 
the  quantity  of  her  milk  during  the  v/hole  time  of 
her  fever,  nor  did  her  infant  fuffer  the  lead  injury 
from  fucking  her  breads. 

I  obferved  tears  to  flow  from  the  ey^e  of  a  young 
woman  in  this  fever,  at  a  time  when  her  mind  feem.ed 
free  from  didrefs  of  every  kind. 

V.  I  prc^ 


BILIOUS    YELLOW    FEVER,    IN     1 794.  37 

V.  I  proceed  next  to  mention  the  fymptoms  of 
this  fever  in  the  nervous  fyflem. 

Delirium  was  lefs  common  than  hid  year.  I 
WHS  much  ftruck  in  obferving  John  Madge,  who 
had  retained  his  reafon  while  he  was  fo  ill  as  to 
require  three  bleedings  a  day,  to  become  delirious 
as  foon  as  he  began  to  recover,  at  which  time  hi? 
pulfe  rofe  from  between  60,  and  70  to  96  flrokes 
in  a  minute.  I  faw  one  cafe  of  extreme  dangler 
in  which  an  hyflerical  laughing  and  weeping  al- 
ternately attended. 

I  have  before  mentioned  the  frequency  of  mania 
as  a  fymptom  of  this  difeafe.  An  obflinate  v/akeful- 
nefs  attended  the  convalefcence  from  this  fever  in 
Peter  Brown,  John  Madge,  and  Mr.  Cole. 

Fainting  was  more  common  in  this  fever  than 
in  the  fever  of  1793.  It  ulliered  in  the  difeafe 
in  one  of  my  patients,  and  it  occurred  in  feveral 
inflances  after  bleeding,  where  the  quantity  of 
blood  drawn  v/as  very  moderate. 

Several  people  complained  of  giddinefs  in  the 
firft  attaft  of  the  fever,  before  they  were  confined 
to  their  beds.  Sighing  was  lefs  common,  but  a 
hiccup  was  more  fo,  than  in  the  year  before. 

c  3  John 


•^.8  A-N    ACCOUNT    OF    THE 

Jolm  Madge  had  an  immobility  in  his  limbs 
bordering  upon  palfy.  A  weaknefs  in  the  wrifls 
in  one  cafe  fucceeded  a  violent  attack  of  the 
fever. 

Peter  Brown  complained  of  a  mod  acute  pain 
in  the  mufcles  of  one  of  his  legs.  It  afterwards 
became  lo  much  inilamed  as  to  require  external 
applications  to  prevent  the  inflammation  terminating 
in  an  abfcefs.  Mrs.  Mitchell  complained  of  fever e 
cramps  in  her  legs. 

The  fenfations  of  pain  in  this  fever  were  often 
.exprelTed  in  extravagant  language.  The  pain  in  the 
head  in  a  particular  manner  w  as  compared  to  repeat- 
ed ilrokes  of  a  hammer  upon  the  brain,  and  in  two 
cafes  in  which  this  pain  was  accompanied  by  great 
heat,  it  w  as  compared  to  the  boiling  of  a  pot.  • 

The  more  the  pains  were  confined  to  the  bones 
and  back,  the  lefs  danger  was  to  be  apprehended 
from  the  difeafc.  I  faw  no  cafe  of  death  from  the 
yellow  fever  in  1793,  where  the  patient  complain- 
ed much  of  pain  in  the  back.  It  is  eafy  to  conceive 
hov/  this  external  determination  of  morbid  a^lion, 
fliould  preferve  more  vital  parts.  The  bilious  fever 
of  J  780  was  a  harmdefs  difeafe,  only  becaufe  it 
/pent  its  >vhole  force  chiefly  upon  the  limbs.     This 

was 


BILIOUS    YELLOW    FEVER,    IN    1 794.  39 

was  fo  generally  the  cafe,  that  it  acquired  from  the 
pains  in  the  bones  which  accompa.nied  it,  the  name 
of  the  "  break  bone  fever.*'  Hippocrates  has  re- 
marked that  pains  which  dcfcend,  in  a  fever,  are 
more  favourable  than  thofe  which  afcend.*  This 
is  probably  true,  but,  I  did  not  obferve  any  fuch 
pecuharity  in  the  tranflation  of  pain  in  this  fever. 
The  following  fa6l  from  Dr.  Grainger  will  add 
weight  to  the  above  obfervations.  He  obferved 
the  pains  in  a  malignant  fever  which  were  diffufed 
through  the  whole  head,  though  excruciating,  were 
much  lefs  dangerous,  than  when  they  were  con- 
lined  to  the  temples,  or  forehead.f 

I  faw  two  cafes  in  which  a  locked  jaw  attended. 
In  one  of  them  it  occurred  only  during  one  parox- 
yfm  of  the  fever.  In  both  it  yielded  in  half  an 
hour  to  blood-letting.  I  met  with  one  cafe  in  which 
there  was  univerfal  tetanus.  I  ihould  have  fufpecfl:- 
cd  this  to  have  been  the  primary  difeafe,  had  not 
two  perfons  been  infe6i:ed  by  the  patient  thus  dif- 
ordered,  with  the  yellow  fever. 

The  countenance  fometimes  put  on  a  ghaflly  ap-     / 
pearance  in  the  height  of  a  paroxyfm^  of  the  fever. 

*  Epidemics,  book  II.  feclion  2. 

\  Hiftoria  iebris  aiiomaia;  Batavse  Annorum  1746,   1747, 
1748,  cup.  L 

c  4  The 


40  AN    ACCOUNT    OF    THE 

The  face  of  a  lady  admired  when  in  health  for  un- 
common beauty,  was  fo  much  diflorted  by  the 
commotions  of  her  whole  fyftem  in  a  fit  of  the  fever, 
as  to  be  viewed  with  horror  by  all  her  friends. 

VI.  The  fenfes  and  appetites  were  affected  in  this 
fever  in  the  following  manner. 

A  total  blindnefs  occurred  in  two  perfons  during 
the  exacerbation  of  the  fever,  and  ceafed  during  its 
remiiTions. — A  great  intolerance  of  light  occurred 
in  feveral  cafes.  It  was  moft  obfervable  in  John 
Madge  during  his  convalefcence. 

A  forenefs  in  the  fenfe  of  touch,  was  fo  exquifite 
in  Mrs  Kapper  about  the  crifis  of  her  fever,  that 
the  prefTure  of  a  piece  of  fine  muflin  upon  her  ikin 
gave  her  pain. 

Peter  Brown  with  great  heat  in  his  fidn,  and 
a  quick  pulfe,  had  no  thirft,  but  a  mofh  intenfe 
degree  of  thiril  was  very  common  in  this  fever.  It 
produced  the  fame  extravagance  of  exprefiTion  that 
I  formerly  faid  was  produced  by  pain.  One  of  my 
patients  Mr.  Cole  faid  he  "  could  drink  up  the 
ocean."  I  did  not  obferve  thirfl  to  be  connecSied 
with  any  peculiar  ftate  of  the  pulfe. 


Georr( 


BILIOUS    YELLOW    FEVER,    IN     I794.  41 

George  Eyre  and  Henry  Clymer,  had  an  unufual 
degree  of  appetite  jufl  before  the  ufual  time  of  the 
return  of  a  paroxyfm  of  fever. 

A  young  man  complained  to  me  of  being  affli^led 
with  no6i:urnal  emiiTions  of  feed  during  his  conva- 
lefcence.  This  fymptom  is  not  a  new  one  in  malig- 
nant fevers.  Hippocrates  takes  notice  of  it.*  I 
met  with  one  inflance  of  it  among  the  fporadic  cafes 
of  yellow  fever  which  occurred  in  1793.  It  fome- 
times  occurs  according  to  Lomius  in  the  commotions 
of  the  whole  fyllem  which  take  place  in  epilepfy. 

VII.  The  difeafe  made  an  ImprefTion  upon  the 
lymphatic  fyflem.  Four  of  my  patients  had  glan- 
dular fwellings :  two  of  them  were  in  the  groin ;  a 
third  was  in  the  parotid  ;  and  the  fourth  v/as  in  the 
maxillary  glands.  Two  of  thefe  fwellings  fup. 
purated. 

VIII.  The  yellownefs  of  the  ilvin  which  fometimes 
attends  this  fever,  was  more  univerfal,  but  more 
faint  than  in  the  year  1793.  It  was  in  many  cafes 
compofed  of  fuch  a  mixture  of  colours  as  to  rcfenible 
polilhed  mahogany.  But  in  a  few  cafes,  the  yellow- 
nefs  was  of  a  deep  orange  colour.  The  former  went 
off  with  the  fever,  but  the  latter  often  continued  for 
feveral  weeks  after  the  patients  recovered.  In  fomc 
*  Epidemics,  book  IV. 

in/lanccG 


42  AN    ACCOUNT    OF    THE 

inilances  a  red  colour  predominated  to  fuch  a  de- 
gree in  the  face  as  to  produce  an  appearance  of  in- 
flammation. 

In  Mrs.  Vogles  a  yellownefs  appeared  In  her  eyes 
during  the  paroxyfm  of  her  fever,  and  went  oiT  in 
its  remiiTions. 

In  James  Lefferty  the  yellownefs  aifefled  every 
part  of  his  body,  except  his  hands,  which  were  as 
pale  as  in  a  common  fever. 

Peter  Brown  tinged  his  flieets  of  a  yellow  colour 
by  night  fweats,  many  v/eeks  after  his  recovery. 

There  was  an  exudation  from  the  foles  of  the 
feet  of  Richard  Wells's  maid,  which  tinged  a  towel 
of  a  yellow  colour. 

•  In  my  Account  of  the  Yellow  Fever  of  1793,  I 
afcribed  the  yellow  colour  of  the  ikin  wholly  to  a 
mixture  of  bile  with  the  blood.  I  am  fatisfied  that 
this  is  the  caufc  of  it  in  thofe  cafes  where  the  colour 
is  deep,  and  endures  for  feveral  weeks  beyond  the 
crifis  of  the  fever ;  but  where  it  is  tranfitory,  and 
above  all,  where  it  is  local,  or  appears  only  for  a 
few  hours  during  the  paroxyfm  of  the  fever,  it  ap- 
pears probable  that  it  is  connedled  v^ith  the  mode 

of 


BILIOUS    YELLOW    FEVER,    IN     1 794.  43 

of  aggregation  of  the  blood,  and  that  it  is  produced 
wholly  by  fome  peculiar  a£lion  in  the  blood-velTels. 
A  fimiiar  colour  takes  place  from  the  bite  of  certain 
animals,  and  from  contufions  of  the  fkin ;  in  nei- 
ther of  which  cafes  has  a  fufpicion  been  entertained 
of  an  abforption  or  mixture  of  bile  with  the  blood. 

A  troublcfome  itching,  with  an  eruption  of  red 
blotches  on  the  ficin,  attended  on  the  firll  day  of  the 
attack  of  the  fever  in  Mrs.  Gardiner. 

A  roughnefs  of  the  Ikin,  and  a  difpofition  in  it 
to  peel  off,  appeared  about  the  crifis  of  the  fever  in 
Mifs  Sally  Evre. 

That  fpecies  of  eruption  which  I  have  elfewhere 
compared  to  mofcheto  bites,  appeared  in  Mrs.  Sellers. 

John  Ray,  a  day  labourer  to  whom  I  was  called 
in  the  laffc  flage  of  the  fever,  had  petechice  on  his 
bread  the  day  before  he  died. 

That  burning  heat  on  the  fkin,  from  which  this 
fever  in  fomc  countries  has  derived  the  name  of 
Caufus^  was  more  common  this  year  than  lafl. 
It  was  fometimes  local,  and  fometimes  general.  I 
perceived  it  in  an  exquifite  degree  in  the  cheeks 
;  only  of  Mifs  Sally  Eyre,  luid  over  the  whole  body 


of 


i'f^- 


44  ^N    ACCOUNT    OF    THE 

of  John  Ray.  It  had  no  conne£]:ion  with  the  ra- 
pidity, or  force  of  the  circulation  of  the  blood  in 
the  latter  inftance,  for  it  was  moil  intenfe  at  a  time 
w^hen  he  had  no  pulfe. 

It  is  remarkable  that  the  heat  of  the  ilvin  has  no 
conneflion  with  the  flate  of  the  pulfe.  This  fa6l 
did  not  efcape  Dr.  Chiiliolm.  He  fays  he  found 
the  fkin  to  be  warm  while  the  pulfe  was  at  52,  and 
that  it  was  fometimes  difagreeably  cold  when  the 
pulfe  was  as  quick  as  in  ordinary  fever.  * 

IX.  I  have  in  another  place  rejected  putrefa£i:ion 
from  the  blood  as  the  caufe  or  efl'e£l  of  this  fever. 
I  iliali  mention  the  changes  which  were  induced  in 
its  appearances  wiien  I  come  to  treat  of  the  method 
of  cure. 

Having  defcribed  the  fymptoms  of  this  fever  as 
they  appeared  in  different  parts  of  the  body,  I  fliall 
now  add  a  few  obfervations  upon  its  type,  or  ge- 
neral charader. 

I  fhall  begin  this  part  of  the  hiflory  of  the  fever 
by  remarking,  that  we  had  but  one  reigning  difeafe 
in  town  during  the  autumn  and  winter  ;  that  this 
was    a  bilious     remitting,    or    intermitting,     and 

*  P.  117. 

fometimes 


BILIOUS    YELLOW    FEVER,    IN     1 794.  45 

fometimes  a  yellow  fever  ;  and  that  all  the  fevers 
from  other  remote  caufes  than  exhalation  or  conta- 
gion, partook  more  or  lefs  of  the  fymptoms  of  the 
prevailing  epidemic.  As  well  might  we  diftinguilh 
the  rain  which  falls  in  gentle  fliowers  in  Great  Bri- 
tain, from  that  which  is  poured  in  torrents  from  the 
clouds  in  the  Weft  Indies,  by  diiterent  names  and 
qualities,  as  impofe  fpecific  names  and  characters 
upon  the  different  ftates  of  bilious  fever. 

The  forms  in  which  this  fever  appeared  were  as 
follow. 

1.  A  tertian  fever.  Several  perfons  died  of  the 
third  fit  of  tertians  who  were  fo  well  as  to  go 
abroad  on  the  intermediate  day  of  the  fever.  It  is 
no  new  thing  for  m.alignant  fevers  to  put  on  the 
form  of  a  terti2.n.  Hippocrates  long  ago  remarked, 
that  intermittents  fometimes  degenerate  into  malig- 
nant acute  difeafes  ;  and  hence  he  advifes  phyficians 
to  be  upon  their  guard  on  the  5th,  7th,  9th,  and 
even  on  the  14th  day  of  fuch  fevers.  * 

2.  It  appeared  moft  frequently  in  the  form  of  a  re- 
mittent. Tlie  exacerbations  occurred  moft  commonly 
m  the  evening.     In  fome  there  were  exacerbations; 


*  Dsi  Moib,  Popular.  L.  VII, 


m 


4-6  AM    ACCOUNT    OF    THE 

In  the  morning  as  well  as  in  the  evening.  But  I 
met  with  feveral  patients  who  appeared  to  be  better 
and  worfe  half  a  dozen  times  in  a  day.  In  each  of 
thefe  cafes,  there  were  evident  remiiTions  and  exa- 
cerbations of  the  fever. 

It  aiTumed  in  feveral  inilances  the  fymptoms  of  a 
colic,  and  colera  morbus.  In  one  cafe  the  fever, 
after  the  colic  was  cured,  ended  in  a  regular  inter- 
mittent. In  another,  the  colic  was  accompanied  by 
a  haemorrhage  from  the  nofe.  I  diftinguiihed  this 
bilious  colic  from  that  which  is  excited  by  lighter 
caiifes,  by  its  always  coming  on  with  more  or  lefs  of 
a  chillinefs.  *  The  fymptoms  of  colic  and  colera 
morbus  occurred  m-ofi  frequently  in  June  and  July* 

4.  It  appeared  in  the  form  of  a  dyfentery  In  a 
boy  of  William  Corfield,  and  in  a  man  whom  my 
pupil  Mr.  Alexander  \ifited  in  the  neighbourhood 
of  Harrowgate. 

5.  It  appeared  in  one  cafe  in  the  form  of  an  apo- 

Dlexv. 

6.  It  diiguifed  iti'elf  in  the  form  of  madnefs. 

■'   See  Syder.Iiam,  Vol.  T.  p.  212.. 

I  7.  Durine 


BILIOUS    YELLOW    FEVER,    IN     I794.  47 

7.  During  the  month  of  Novembei,  and  in  all 
the  winter  months,  it  was  accompanied  with  pains 
in  the  fides  and  breafi:,  conflituting  what  nofologifls 
call  the  "  pleuritis  biliofa." 

8.  The  puerperile  fever  was  accompanied  during 
the  fummer  and  autumn,  with  more  violent  fymptoms 
than  ufual.  Dr.  Phyfick  informed  me,  that  two 
women  to  v/hom  he  was  called  foon  after  their  deli- 
very, died  of  uterine  haemorrhages ;  and  that  he  had 
with  diiEcuIty  recovered  two  other  lying-in  women, 
who  were  aflli£led  with  that  fymptom  of  a  malig- 
nant diathefis  in  the  blood-veiTels. 

9.  Even  dropfies  partook  more  or  lefs  of  the  in- 
flammatory and  bilious  chara<^er  of  this  fever. 

10.  It  blended  itfelf  with  the  fcarlatina.  The 
blood  in  this  diforder,  and  in  the  puerperile  fever, 
had  exa£i:ly  the  fame  appearance  that  it  had  in  the 
yellow  fever.  A  yellownefs  in  the  eyes  accompa- 
nied the  latter  difeafe  in  one  cafe  that  came  under 
my  notice. 

A  flight  Ihivering  ufliered  in  the  fever  in  fevcral 
inftances.  But  the  worft  cafes  I  faw,  came  on 
without  a  chilly  fit^  or  the  leafl  fenfe  of  coldnefs 
in  any  p2.Tt  o^  the  body. 

Such 


48  AN    ACCOUNT    OF    THE 

Such  was  the  predominance  of  the  intermitting^ 
remitting,  and  bilious  fever,  that  the  mealies,  the 
fmall-pox,  and  even  the  gout  itfelf,  partook  more  or 
lefs  of  its  character.  There  were  feveral  inftances  in 
which  the  meafles,  and  one,  in  which  the  gout  ap- 
peared with  quotidian  exacerbations  ;  and  two  in 
which  madnefs  appeared  regularly  in  "the  form  of  a 
tertian. 

I  mentioned  formerly  that  this  fever  fometimes 
went  oiT  with  a  Aveat,  when  it  appeared  in  a  tertian 
form.  This  was  alv/ays  the  cafe  with  the  fecond 
grade  of  the  fever,  but  never  with-  the  firil  degree 
of  it  before  the  3d  or  4th  paroxyfm  of  the  fever  ; 
nor  did  a  fweat  occur  on  the  5th  or  7th  day,  except 
sfter  the  vSc  of  depleting  remedies.  This  peculia-* 
rity  In  the  fever  of  this  year  was  fo  fixed,  that  it 
gave  occafion  for  my  comparing  it  in  my  intercourfe 
with  my  patients,  to  a  lion  on  the  firfl  feven  days, 
and  to  a  Iamb  during  the  remaining  part  of  its  du-* 
i*ation. 

The  fever  differed  from  the  fever  of  -the  prece-^ 
ding  year  in  an  important  particular.  I  faw  or 
heard  of  no  cafe  which  terminated  in  death  on  the 
firft  or  third  day.  In  every  cafe,  the  fever  cam^e  on 
fraught  v/ith  paroxyfms.  The  moderate  degrees  of 
it  were  of  fo  chronic  a  nature  as  to  continue  for 

^  feveral 


BILIOUS    YELLOW    FEVEk,    IN    1 794.  4^ 

ieveral  weeks  when  left  to  themfelves.  I  willi  thi^ 
peculiarity  in  the  epidemic  which  I  am  now  de- 
fcribing,  to  be  remembered ;  for  it  will  ferve  here- 
after to  explain  the  reafon  why  a  treatment  appa-' 
rently  different,  flionld  be  alike  fuccefsful  in  differ- 
ent feafons  and  in  different  countries. 

The  crifis  of  the  fever  occurred  on  uneven  days 
more  frequently  than  in  the  fever  of  the  year  1793* 

I  remarked  formerly  *  that  remifTions  wer^  more 
common  in  the  yellow  fever  than  in  the  common 
bilious  fever.  The  fame  obfervation  applies  to 
critical  days.  They  were  obfervable  in  almofl  every 
cafe  in  which  the  difeafe  was  not  flrangled  in  its 
birth.  Dr.  Chifholm  defcribes  the  fame  peculiarity 
in  the  Boullam  fever.  "  1  have  not  met  with  any 
difeafe  (fays  the  Do6lor)  in  which  the  periods  were 
more  accurately  afcertained."  f 

The  unity  of  the  flates  of  fever  of  the  autumn 
appeared,  not  only  in  the  famenefs  of  fome  of  their 
mod  charafleriilic  fymptoms,  but  in  their  mutually 
propagating  each  other.  The  rnofl  malignant  flates 
of  yellow  fever  were  propagated  from  a  moderate 
remittentj  in  a  fervant  girl  in  Mr.  Mitchell's  family, 

*  Account  of  the  Vellow  Fever  of  179$.         f  ^'  ^4^* 
VOL,  IV.  ©  and 


s^ 


AN    ACCOUNT    OF    THE 


and  a  moderate  remittent  was  created  in  two  per- 
fons  by  a  man  who  died  of  the  yellow  fever. 

In  addition  to  the  inftances  formerly  enumera- 
ted *,  of  the  predominance  of  powerful  epidemics 
over  other  difeafes,  I  fnall  add  two  more,  which  I 
have  lately  met  v/ith  in  the  courfe  of  my  reading. 

Dr.  Chilliolm,  in  defer ibing  the  peflilential  fever 
introduced  into  the  Well  Indies  from  Boullam,  has 
the  following  remarks.  "  Mod  other  difeafes  de- 
generated into,  or  partook  very  much  of  this.  Dy- 
fenterics  fuddenly  flopped,  and  were  immediately 
fucceeded  by  the  fymptoms  of  the  peflilential  fever. 
Catarrhal  complaints,  fimple  at  firfl,  foon  changed 
their  nature  :  convalefcents  from  other  difeafes  were 
very  fubjecl  to  this,  but  it  generally  proved  mild. 
Thofe  labouring  at  the  fame  time  under  chronic 
complaints,  particularly  rheumatifm  and  hepatitis, 
were  very  fubje£l  to  it.  The  puerperile  fever  be- 
came malignant,  and  of  courfe  fatal ;  and  even  preg- 
nant negro  women,  who  other  wife  might  have  had 
it  in  the  ufual  mild  degree  peculiar  to  that  defcrip- 
tion  of  people,  were  reduced  to  a  very  dangerous 
fituation  by  it.  In  fliort,  every  difeafe  in  which  the 
patient  was  liable  to  infection,  fooner  or  later  af- 

*  Account  of  the  Yellow  Fever,  in  1793. 

fumed 


BILIOtJS    YELLOW    FEVER,    IN    I794.  yi 

fumed  the  appearance,  and  acquired  the  danger  of 
the  peftilential  fever."  * 

It  is  worthy  of  notice,  that  the  fever  defcribed 
by  Dr.  Chilholm  did  not  infe£l  beyond  the  diflance 
of  ten  feet.  Let  us  not  be  furprifed  therefore^ 
that  the  yellow  fever  which  infe£i:s  acrofs  ftreets, 
fliQuId  impart  its  fy mptoms  to  all  other  difeafes. 

Dr.  Defportes  afcrlbes  the  fame  unlverfal  empire 
to  the  yellow  fever  which  prevailed  in  St»  Domingo 
in  the  fumm.er  of  1733.  "  The  fever  of  Siam  (fays 
the  Do£i:or)  conveyed  an  infinite  number  of  men  to 
the  grave  in  a  fliort  time ;  but  I  faw  but  one  wo. 
man  who  was  attacked  by  it/' 

"  The  violence  of  this  difeafe  was  fuch,  that  it 
fubjefled  all  other  difeafes,  and  reigned  alone.  This 
is  the  chara^ler  of  all  contagious  and  peftilential 
difeafes.  Sydenham,  and  before  him  Diemerbroek, 
have  remarked  this  of  the  plague."  f 

In  Baltimore  the  fmall-pox  in  the  tiatural  way 
was  attended  with  unufual  malignity  and  morta- 

*  P.  129,  130. 

f  P.  40,  41,     See  alfo  p.  iii — 230)  231=  Vol.  1, 

D  2  Htyj, 


t*  AN    ACCOUNT    OF    THE 


J 


lity,  occaiioned  by  its  being  combined  with  the  reign- 
ing yellow  fever. 

It  has  been  urged  as  an  obje£iion  to  the  influence 
of  powerful  epidemics  chafmg  away,  or  blending 
with  fevers  of  inferior  force,  that  the  meafles  fome- 
times  fupplant  the  fmall-pox,  and  mild  intermittents 
take  the  place  of  fevers  of  great  malignity.  This 
fa£l  did  not  efcape  the  microfcopic  eye  of  Dr. 
Sydenham,  nor  is  it  difEcult  to  explain  the  caufe  of 
it.  It  is  w^ell  known  that  epidemics,  like  fimple 
fevers,  are  moll  violent  at  their  firfl  appearance, 
and  that  they  gradually  lofe  their  force  as  they  dif- 
appear  5  now  it  is  in  their  evanefcent  and  feeble  ftate, 
that  they  are  jollied  out  of  their  order  of  danger  or 
force,  and  yield  to  the  youthful  flrength  of  epide- 
mics, more  feeble  under  equal  circumftances  of  age 
than  tliemfelves.  It  would  feem  from  this  fa£l:,  that 
an  inflammatory  conflitution  of  the  air,  and  power- 
ful epidemics  both  in  their  aggregate  and  individual 
forms,  pqfTelTed  a  common  charadler.  They  all  in- 
vade with  the  fury  of  a  favage,  and  retire  with  the 
gcn^lenefs  of  a  civilized  foe. 

It  is  agreeable  to  difcover  from  thefe  fafts  and 
obfervations,  that  epidemic  difeafes,  however  irre- 
gular they  appear  at  £rfl  fight,  are  all  fubjedt  to  cer- 
tain laws,  and  partake  of  the  order  and  harmony  of 

the  univerfe* 

I  have 


BILIOUS    YELLOW    FEVER,    IN   -I794.  53 

I  have  remarked  that  this  fever  was  contagious 
in  a  very  few  inflances  compared  with  the  preceding 
year,  but  its  operation  upon  the  body,  where,  from 
the  abfence  of  an  exciting  caufe,  it  did  not  produce 
fever,  was  the  fame  as  I  have  elfewhere  defcribed» 
The  fenfations  which  I  experienced  in  entering  a 
room  where  a  perfon  Was  confined  with  this  fever, 
were  fo  exa<5i:ly  the  fame  with  thofe  I  felt  the  year 
before,  that  I  think  I  could  have  diflinguiflied  the 
prefence  of  the  difeafe  without  the  aiTiftance  of  my 
eyes,  or  without  afking  a  fmgle  queftion.  After 
fitting  a  few  minutes  near  a  perfon  ill  with  this  fever 
I  became  languid,  and  fainty.  Weaknefs  and  chilli- 
nefs,  followed  every  vifit  I  paid  to  a  gentleman  at 
Mr.  Oeliers's  hotel,  which  continued  for  half  an 
hour.  A  burning  in  my  llomach,  great  heavinefs, 
and  a  flight  infiam.mation  in  my  eyes  with  a  conftant 
difcharge  of  a  watery  humour  from  them  for  two 
days,  fucceeded  the  firfl  vifit  I  paid  to  Mrs.  Sellers. 
Thefe  fymptoms  came  on  in  lefs  than  ten  minutes 
after  I  left  her  room.  They  were  probably  excited 
thus  early,  and  in  the  degree  which  I  have  mention^ 
ed,  by  my  having  received  her  breath  in  my  face  by 
infpe^iingher  tonfils,  Vv^hich  were  ulcerated  on  the  firfl 
attack  of  the  fever.  Three  days  after  my  eyes  re- 
covered from  their  watery  and  inflamed  fl:ate,  I  was 
expofed  to  the  acTtion  of  the  contagion  in  a  con- 
centrated  fl:ate  by    bleeding    Mrs.    Lloyd    Jones. 

D  3  One 


54'  AN    ACCOUNT    OF    TKE 

One  of  my  eyes  again  became  fore,  and  difcliarged 
water  for  tv/o  or  three  days  afterwards.  I  have 
related  thefe  fa£!:s  chiefly  with  a  view  of  offering  a 
conjecture  as  to  the  caufe  of  the  univerfal  preva- 
lence of  opthahnias,  or  what  are  called  fore  eyes, 
during  the  prevalence  of  great  and  powerful  epi- 
demics.* They  were  common  in  all  the  fickly  parts 
of  the  United  States,  in  the  year  1793,  and  ap- 
peared in  many  places,  as  well  as  in  Philadelphia 
in  the  Autumn  of  1794.  They  are  probably  oc- 
cafioned  by  a  feeble  and  partial  action  of  exhalation 
or  contagion  upon  the  fyflem. 

I  recolleift  having  more  than  once  perceived  a 
fmell  which  had  been  familiar  to  me  during  the  time 
I  was  expcfed  to  the  contagion  of  the  yellow  fever 
in  1793.  It  refembled  the  fmell  of  the  liver  of 
fulphur.  I  fufpecled  for  a  while  that  it  arofe  from 
the  exhalations  of  the  gutters  of  the  city.  But  an 
accident  taught  me  that  it  was  produced  by  the 
perfpiration  of  my  body.  Upon  rubbing  my  hands, 
this  odor  was  encreafed  fo  as  to  become  not  only 
more  perceptible  to  mjfelf,  but  in  the  m-oft  fenfible 
degree  to  my  pupil  Mr.  Otto.  From  this  h£t  I 
was  fatisfied  that  I  was  flrongly  impregnated  with 
tlie  contagion,  and  I  was  led  by  it  to  live  chiefly 

*  Hippocrates's  Epidemics. 

upon 


BILIOUS    YELLOW    FEVER,    IN    1794.  55 

upon  vegetables,  to  drink  no  wine,  and  to  avoid 
with  double  care,  all  the  ufual  exciting  caufes  of 
fever. 

There  was  another  mark  by  which  I  diflinguiilied 
the  prefence  of  the  contagion  of  this  fever  in  my 
fyftem,  and  that  was,  wine  imparted  a  burning  fen- 
fation  to  my  tongue  and  throat,  fuch  as  is  felt 
after  it  has  been  taken  in  excefs,  or  in  the  beginning 
fo  a  fever.  Several  perfons  who  were  expofed  to 
the  contagion  of  this  fever  informed  me  that  wine 
even  in  the  fmalleft  quantity,  afFeiSled  them  exactly 
in  the  fame  manner. 

I  faw  one  inflance  in  which  the  difeafe  was  ex- 
cited in  twelve  hours  after  the  contagion  was  taken 
into  the  body.  A  lady  lately  from  Rhode  Illand 
who  laid  fo  near  a  fick  gentleman  in  a  public  houfe 
as  to  be  diflurbed  by  his  groans,  humanely  went 
into  his  room  in  the  mornino;  to  offer  him  all  the 
relief  that  lay  in  her  power.  She  found  him  in  the 
a6i:  of  puking  black  matter,  and  was  much  fliocked 
at  the  yellow  colour  of  his  face.  She  did  not  fufpccl 
his  diforder  to  be  the  yellow  fever,  for  his  phy- 
ficians  had  denied  or  concealed  it  in  the  family. 
The  fpeedy  death  of  this  gentleman  induced  her  to 
change  her  lodgings.  In  the  evening  of  the  fame  day 
file  went  to  the  theatre,  where  fhe  was  feized  with  a 

D  4  chilly 


56  AN    ACCOUNT    OF   THE 

chilly  fit.  The  next  day  I  was  fent  for  to  vifit  her, 
I  found  her  ill  with  all  the  fymptoms  of  the  yellow 
fever.  She  was  cured,  but  the  danger  and  diflrefs 
from  which  flie  efcaped,  furniilied  an  affecling  in- 
flance  of  the  cruelty  of  concealing  or  denying  the 
exiftence  of  contagious  ^^.nd  malignant  difeafes. 

The  contagious  quality  of  this  fever  I  have  re- 
marked, was  not  confined  to  its  moll  malignant  de- 
grees. Malignity  in  a  fever  is  not  eiTential  to  the 
generation  of  contagion.  Under  certain  circum- 
fiances  of  the  atmofphere,  the  mildell  intermittentg 
are  fometimes  propagated  by  contagion. 

I  attended  four  perfons  in  this  fever  who  had  had 
ijt,  the  year  before. 

I  have  mentioned  elfewhere  that  the  comm.on 
modes  of  preventing  the  a6lion  of  contagion  on 
the  fyftem  had  not  only  failed,  but  had  probably 
favoured  the  fpreading  of  the  fever  in  1793.  I  was 
made  happy  by  obferving  th9,t  Dr.  Chifholm  had 
hovnc  a  teilimony  againit  them,  in  his  account  of  the 
jail  fever  of  Grenada,  It  is  by  deflroying  a  con- 
fidence in  fuppofed  preventives  of  the  difeafe,  that 
we  iliall  lead  people  to  the  more  rational  ones  of  tem^ 
perance  and  gentle  dofes  of  phyfic.  To  a  vegetable 
diet  may  be  added  fuch.  a  mixture  of  pepper  as  fh^Il 

keep 


BILIOUS    YELLOW    FEVER,    IN    1 794.  57 

keep  up  a  conftant  and  vigorous  tone  in  the  ftomacli 
and  bowels,  without  imparting  the  leafl  new  a(^ion 
to  the  blood  velTels.  Mr.  Bruce  fays  in  his  travels, 
that  in  one  of  the  fickly  countries  which  he  vifited, 
the  inhabitants  obviated  malignant  fevers,  by  this 
practice.  The  quantity  of  pepper  mixed  with  their 
rice  was  fo  great  (he  fays),  as  to  inflame  the  throats 
of  perfons  who  we^e  not  accuftomed  to  it.  To  this 
preventive,  they  add,  abflinence  from  ardent  fpirits, 
from  weak  broths,  and  decayed  fruit.  They 
moreover  eat  their  principal  meat  after  fun-fet, 
when  the  coolnefs  of  the  night  air  imparts  a  tone 
to  the  Homach  and  thereby  facihtates  digeftion. 

It  may  appear  paradoxical  at  lirfl  fight,  how 
generous  living  fliould  proteft  frgm  common  bilious, 
and  low  jail  fevers,  while  it  encreafes  the  predifpo- 
fition  to  the  yellow,  and  other  peflilential  fevers. 
The  reafon  is  plain.  The  action  in  the  blood  veiTels 
in  the  common  bilious  and  j^il  fevers  is  fo  feeble, 
that  a  full  diet  creates  an  a£lion  in  the  veffels  fupe- 
rior  to  it,  while  the  a6i:ion  excited  by  the  contagion 
of  peflilential  fevers  is  fo  violent,  as  not  only  to 
refufe  to  yield  to  the  flimulus  of  diet,  but  to  be 
greatly  increafed  by  it. 

Mr.  Bruce  relates  further  that  thofe  perfons,  who 
lived  in  fmoky  hcufes,  efcaped  bilious  fevers.     The 


58  AN    ACCOUNT    OF    THE 

cfFe<5i:  of  fmoke  in  checking  contagion  was  evident, 
in  the  hofpitals  conflru6led  without  chimneys  by  Dr. 
Tilton,  during  the  late  war.  The  fire  was  kindled 
hi  the  middle  of  the  earthen  floor  of  the  hofpital  in 
a  hole  made  in  the  earth,  and  the  fmoke  after  per- 
vading the  room,  efcaped  through  a  hole  in  the 
roof  of  the  building  in  a  perpendicular  dire£l:ion  to 
the  fire  place.  Dr.  Clark  has  added  another  facl 
in  favor  of  the  prophylactic  virtues  of  fmoke.  In 
one  inftance  which  came  under  his  notice,  it  pre- 
ferved  the  cooks  who  worked  in  a  galley  from  being 
aire6i:ed  by  a  contagious  fever.* 

I  have  hitherto  mentioned  the  means  of  prevent- 
ing the  attack  of  this  fever  upon  individuals.  I 
ihall  now  add  a  few  dire6lions  for  preventing  its  ad- 
miffion  and  propagation  in  cities. 

ifl.  Let  a  law  be  paiTed  to  compel  phyficians, 
under  a  fevere  penalty,  to  report  to  a  Committee  ap- 
pointed for  that  purpofe,  the  exifhence  of  a  malignant 
contagious  fever,  as  foon  as  they  difcover  it  in  any 
part  of  the  city.  Let  this  Committee  call  a  council 
of  phyficians  to  examine  the  cafe  fo  reported  ;  and 
if  a  majority  of  them  concur  in  opinion  of  its  con- 
tagious and  dangerous  nature,  let  the  following  fleps 
be  taken. 

*  Vol.  Lp.  166. 

2d]y. 


BILIOUS    YELLOW    FEVER,    IN    1794.  59 

:2dl75  If  t'  e  fever  appear  to  have  been  Imported 
from  a  foreign  country,  let  the  infeiTted  veffel  be 
removed  from  the  wharf,  and  carefully  wafhed  and 
fumigated  in  the  channel  of  the  river,  and  let  her 
cargo,  if  any  part  of  it  has  been  landed,  be  conveyed 
from  the  city. 

3dly.  If  the  fever  appear  to  be  of  domeflic 
origin,  let  the  putrid  matter  which  produced  it  be 
removed,  or  covered,  fo  as  efFe£lually  to  deilroy  all 
pofTibility  of  future  exhalation  from  it.  While  thefe 
precautions  are  going  forv/ard, 

4thly.  Let  all  the  families  which  are  within 
fifty  yards  of  the  infe(51:ed  perfon  or  perfons  be 
ordered  inflantly  to  remove  into  hcufes  or  tents,  to 
be  provided  for  them  at  the  public  expenfe.  Let 
chains  then  be  placed  acrofs  the  ftreets  which  lead 
to  the  fick,  and  let  guards  be  appointed  to  prevent 
all  accefs  to  the  infe^led  parts  of  the  city,  except 
by  phyficians,  and  nurfes,  and  fuch  other  perfons  as 
are  neceflary  to  be  employed  in  a  manner  to  be 
jTientioned  prefcntly. 

The  plan  of  removing  the  well  inilead  of  the  lick, 
to  prevent  the  progrefs  of  peftilential  fevers  is  not 
a  new  one.     It  has  been  pra^lifed  with  fuccefs  m 
RufTia,  and  it  has  the  following  circumftanccs  to  re- 
commend 


6o  AN    ACCOUNT    OF    THE 

commend  It.  i.  It  will  prevent  the  contagion  being 
fpread  by  the  Tick  in  paiTmg  through  the  ftreets  out 
of  the  city.  2.  It  will  not  be  repugnant  to  hu- 
manity ;  for  if  the  fick  be  not  fuddenly  deflroyed  by 
being  informed  of  the  cruel  fate  which  awaits  them_, 
they  often  perifli  from  the  motion  which  is  neceiTary 
to  remove  them,  or  from  the  anguifli  of  being  torn 
from  their  families,  or  friends.  3.  The  difcovery, 
and  declaration  of  the  exiilence  of  malignant  and 
contagious  fevers  will  be  early,  and  unequivocal^ 
when  an  expulfion  from  the  city  will  not  be  dreaded 
from  it,  and  when  the  danger  of  the  difeafe  will 
thereby  be  leiTened,  by  the  ceafmg  of  noifes  of  all 
kinds  in  the  neighbourhood,  and  the  improbability 
of  the  fiek  creating  a  refle^led  atmofphere  of  conta- 
gion from  the  perfons  who  may  be  infefled  by 
them, 

5.  After  the  creation  of  the  temporary  defert  in 
the  neighbourhood  of  the  fick  (which  may  be  done 
without  their  knowledge)  let  the  procefs  of  nature 
for  deflroying  contagion  and  morbid  exhalations  be 
imitated.  Let  artificial  fliowers  of  rain  be  poured 
down  by  means  of  fire  engines  upon  the  infe61:ed 
houfes  and  upon  the  adjacent  parts  of  the  flreets, 
two  or  three  times  a  day.  This  may  be  done  by 
means  of  the  city  engines  ufed  for  extinguilhing 
fire. 

The 


BILIOUS    YELLOW    FEVER,    IN    I794.  6i 

The  wealthy  inhabitants  of  Smyrna  preferve 
themfelves  in  health  by  thus  wetting  their  houfes, 
while  the  plague  is  deftroying  thoufands  of  their  leis 
opulent,  or  provident  neighbours. 

Let  it  not  be  inferred  from  the  enumeration  of 
the  means  of  preventing  the  contagion  of  this  fever, 
that  I  admit  a  contagious  nature  to  be  one  of  its 
chara<^eriflic  marks.  Far  from  it.  It  is  an  acci- 
dental circumflance  produced  chiefly  by  the  con- 
currence of  the  weather.  The  following  ftatement 
of  fafts  relative  to  its  contagious  charadler  in  dif- 
ferent feafons,  and  countries,  is  the  refult  of  much 
inquiry  upon  this  fubjeft. 

ifl.  It  is  in  no  inilance  contagious  in  fome  cafes. 

2dly.  It  is  fometimes  propagated  by  ftrangers, 
to  llrangers  only,  in  the  Well  Indies. 

3dly.  It  fometimes  afFe£i:s  the  natives,  as  well  as 
ftrangers,  in  the  Weil  India  lilands. 

4thly.  It  affe^ls  ftrangers,  natives,  and  negroes 
in  fome  inflances.  This  was  the  cafe  in  Philadel- 
phia in  1793,  and  in  Norfolk  in  1795. 

5thly.  It  afFecls  adults  only,  and  none  under 
puberty,  as  in  Jamaica  according  to  Dr,  Hume. 

6thly, 


£l  AN    ACCOUNT    OF    THE 

(Jthly.  It  afFccTts  adults  and  children  of  all  ages. 
This  was  evident  in  Philadelphia  in  1793. 

yihly.  It  affe£l:s  other  animals  as  well  as  the 
Imman  fpecies.  It  affecfted  fowls  and  ducks  in  New 
York  in  the  year  1795,  and  it  affe^bed  cattle  in 
Yirgitiia.  as  I  ihall  fay  prefently,  in  the  year  1794. 

Sthly.  It  .affefls  the  inhabitants  of  cities,  and 
Ti-ot  of  the  country,  as  in  Charleflon  in  the  years 
1732,  1739,  17455  and  1748,  and  in  Philadelphia 
in  the  year  1793. 

9thly.  It  afFe<fl:3  the  inhabitants  of  both  cities^ 
^nd  country,  as  in  the  flate  of  New  York  in  the 
year  1791.*^ 

From  thefe  fa '51s  it  would  appear,  that  to  fuppofe 
this  fever  ihould  infeft  uniformly  in  all  cafes  in  order 
to  acquire  a  contagious  character,  is  as  abfurd  as  to 
fuppofe  that  cold  and  heat  do  not  produce  inflam- 
matory fevers,  becaufe  thoufands  of  people  are  con- 
ftantly  expofed  to  them,  without  being  indifpofed. 
An.  aptkude  or  predifpofition  from  feafon,  climate, 
or  conflitution,  muft  concur  to  render  the  contagion 
of  this,  as  well  as  other  malignant  fevers  futHciently 

*  I>r,  Addoms's  Thefis^ 


BILIOUS    YELLOW    FEVER,    IN    1 794.  63 

ai^ive  to  produce  a  difeafe.  As  well  might  a  tra- 
veller attempt  to  defcribe  the  climate  of  a  new- 
country,  from  the  hiftory  of  a  fmgle  feafon,  as  a 
phyfician  fix  the  character  of  an  epidemic  from  its 
appearance  in  one  feafon,  or  in  one  country.  To 
know  a  difeafe  perfectly,  it  fliould  be  feen,  or 
fludied  in  fucceffive  feafons,  and  in  different  coun* 
tries. 

It  remains  now  that  I  mention  the  origin  of  this; 
fever.  This  was  very  evident.  It  was  produced 
by  the  exhalations  from  the  gutters,  and  the  flag- 
nating  ponds  of  water  in  the  neighbourhood  of  the 
city.  Where  there  was  moil  exhalation,  there  were 
moll  perfons  affefled  by  the  fever.  Hence  the  poor 
people,  who  generally  Hve  in  the  neighbourhood  of 
the  ponds  in  the  fuburbs,  were  the  greateil  fufferers 
by  it.  Four  perfons  had  the  fever  in  Spruce,  be- 
tween Fourth  and  Fifth  Streets,  in  which  part  of 
the  city,  the  fmell  from  the  gutters  was  extremely 
offenfive  every  evening.  In  Water  Street  between 
Market  and  Walnut  Streets,  many  perfons  had  the 
fever :  now  the  filth  of  that  confined  part  of  the 
city  is  well  known  to  every  citizen. — I  have  before 
remarked  that  one  reafon  why  mofl  of  our  phyficians 
refufed  to  admit  the  prefence  of  the  yellov/  fever 
in  the  city,  was  becaufe  they  could  not  fix  upon  a 
veftige  of  its  being  imported.     On  the  25th   of 

Augufl 


^4  AN    ACCOUNT    OF    TH£ 

Augufl  the  Brig  Commerce  arrived  in  tlie  river 
from  St.  Mark,  commanded  by  Captain  ShirtliiE 
After  I]' ing  five  days  at  the  Fort  ftie  came  up  to  the 
city.  A  boy  who  had  been  iliut  out  from  his  lodgings, 
went  in  ailate  of  intoxication,  and  llept  on  her  deck, 
expofed  to  the  night  air,  iii  confequence  of  which 
the  fever  was  excited  in  him.  This  event  gave  oc- 
cafion  for  a  few  days  to  a  report  that  the  difeafe  was 
imported,  and  feveral  of  the  phyficians  who  had 
negle£led  to  attend  to  all  the  circumftances  that 
have  been  flated,  admitted  the  yellow  fever  to  be 
in  town.  An  invefligation  of  this  fuppofed  origin 
of  the  difeafe  foon  difcovered  that  it  had  no  foun- 
dation. At  the  time  of  the  arrival  of  this  fliip  I 
had  attended  nearly  thirty  pdffons  with  the  fever, 
and  upwards  of  an  hundred  had  had  it,  under  the 
care  of  other  phyficians. 

Since  the  publication  of  my  proofs  of  the  gene- 
ration of  the  yellow  fever,  in  our  city  in  the  year 
1793,  I  have  had  many  reafons  to  be  confirmed  in 
the  opinion  I  then  defended.  My  arguments  have 
Carried  canvi<Siion  to  the  mJnds  of  evefy  unpre- 
judiced citizen  of  the  United  States.  Dr.  Prieillsy, 
whofe  knowledge  and  judgment  upon  fubje<5ls  ccn- 
flecked  with  volatile  fluids,  whether  pure  or  impure, 
itiuik  be  admitted  by  ail  who  know  him,  has  admit* 
ted  my  fae^s  and  reafonings,  notwithflanding  he  fat 

down 


BILIOUS    YELLOW    FEVER,    IN    I794.  63 

down  to  read  them  under  the  influence  of  prejudiced 
on  the  other  fide  of  the  queflion.  Dr.  Black  the 
father  of  modern  chemiflry,  has  hkewife  admitted 
my  opinion  of  the  origin  of  the  yellow  fever,  of 
1793,  in  a  converfation  with  my  former  pupil  Dr, 
Coxe  in  Edinburgh.  The  two  following  fadts  wiii 
help  ftill  further  to  eilablifli  the  origin  of  the  bilious 
fever  in  its  different  grades,  from  vegetable  putre- 
fadlion,  and  will  fliew  that  in  medicine,  as  well  as 
in  government,  great  events,  often  fpring  from  httle 
caufes.  In  a  letter  I  received  near  two  years  ago 
from  Dr.  George  Davidfon  of  the  ifland  of  St.  Vin- 
cents dated  July  22d  1794,  is  the  following  com- 
munication. 

"  The  yellow  fever  is  evidently  produced  by  a 
peculiar  itate  of  the  air,  and  by  marih  exhalations. 
The  fituation  of  thofe  habitations  where  it  firfl  ap- 
pears, near  to  ftagnant  water,  or  fwamps,  point  out 
this  to  be  its  origin.  The  governor's  guard  on  this 
Ifland  was  fliationed  in  an  old  bathing  houfe.  The 
fhream  of  water  which  had  run  through  it,  had  been 
diverted  from  it,  but  a  quantity  of  mud  and  filth 
had  been  allowed  to  accumulate  in  a  watering  fl:one 
trough  near  the  door ;  in  confequence  of  which 
feveral  of  the  guards  were  feized  before  morning 
with  the  ufual  fymptom?  of  the  yellow  fever.  Above 
ten  died  before  the  caufe  was  difcovered,  and  im- 
voL.  IV.  E  mediately 


6^  AN    ACCOUNT    OF    THE 

mediately   upon  removing   it,   the   guard  becams 
healthy/' 

The  children  of  a  family  in  this  city,  were  ob- 
ferved  for  feveral  fucceiTive  years  to  be  afFe<5ted  by^ 
a  bilious  remitting  fever.  The  phyfician  of  the 
family  the  late  Dr.  Phineas  Bond,  obferving  no 
other  perfons  to  be  aifciSled  in  the  fame  way  in  the 
neighbourhood,  fufpe^led  that  the  fever  arofe  from 
fome  local  caufe.  He  examined  the  yard  belonging 
to  the  houfe,  where  he  found  an  offenfive  duck 
pond.  This  pond  was  filled  up,  and  the  family 
remained  afterwaids  free  from  an  annmal  bilious 
fever. 

Sporadic  cafes  of  fever^  I  believe,  are  often  created 
by  the  noxious  air  of  water  courfes,  cellars,  and 
fmks  of  houfes  that  are  equally  unfufpe^iied  with 
the  filth  of  the  duck  pond.  A  citizen  of  Philadel- 
phia who  had  a  fink  in  his  kitchen,  lofl  a  number  of 
dogs  and  cats  by  convulfions.  At  length  one  of  his 
fervants  was  afFe(fi:ed  with  the  fame  diforder.  This 
led  him  to  invefligate  the  caufe  of  it.  He  foon 
traced  it  to  his  fink.  By  altering  its  conllru^ion^ 
fo  as  to  prevent  the  efcape  of  noxious  air  from  it, 
he  defiroyed  its  unwholefome  quality,  fo  that  dogs 
and  cats  lived  in  good  health  afterwards  in  his 
kitchen  ► 

la 


BILIOUS    YELLOW    FEVER,    IN    I794.  6f 

'  In  my  former  publication  upon  the  yellow  fever, 
I  mentioned  the  effe^ls  of  heavy  rains  in  checking 
it.  But  feveral  obfervations  made  in  the  Weft  In> 
dies  prove  that  this  efFe£i:  of  rain  is  not  uniform. 
The  following  fadl  extracted  from  a  fecond  letter  from 
Dr.  Davidion,  dated  the  12th  of  November  1794, 
will  explain  the  caufe  of  the  occafional  deviations 
from  the  general  remark  upon  this  fubjefl. 

"  Being  ordered  (fays  the  Do£i:or)  up  to  Bar- 
badoes  laft  November  upon  fervice,  I  found  that  the . 
troops  there  had  fuitered  confiderably  by  that  for-* 
midable  fcourge  the  yellow  fever.  The  feafon  had 
been  remarkably  dry.  It  was  obferved  that  a  rainy 
feafon  contributed  to  make  the  troops  healthier^ 
excepting  at  Conftitution  hill,  where  the  fixth  regi-* 
ment  was  ftationed,  and  where  a  heavy  fliower  of 
rain  never  failed  to  bring  back  the  fever  after  it 
had  ceafed  for  fome  time.  I  found  the  barrack 
where  this  regiment  was,  furrounded  by  a  pond  of 
brackifli  water,  which  being  but  imperfectly  drained 
by  the  continuance  of  the  drought,  the  furface  w^as 
covered  with  a  green  fcum  which  prevented  the  ex- 
halation of  marfliy  exhalation.  After  a  heavy 
fhower  of  rain  this  fcum  was  broken,  and  the  miaf- 
mata  were  evolved,  and  aCled  with  double  force 
in  proportion  to  the  time  of  their  retention." 

E  2  Th^-i 


6S  AN    ACCOUNT    OF    THI 

The  generation  of  the  yellow  fever  in  our  city 

was  rendered  more  certain  by   the  prevalence  of 

bilious  difeafes  in  every  part  of  the  United  States, 

and  in  feveral  of  them,  in  the  grade  of  yellow  fever. 

It  was  common  in  Charleflon  in  South  Carolina, 

where  it  carried  off  many  people,  and  where  no  fuf- 

picion  was  entertained  of  its  being  of  Weft  India 

origin.     It  prevailed  with  great  mortality  at  that 

part  of  the  city  of  Baltimore  which  is  known  by  the 

name  of  FelFs  Point,  where  Dr.  Dryfdale  aifures 

mc  it  was  evidently  generated.     A  few  fporadic 

cafes  of  it  occurred  in  New  York,  which  were  pro^ 

duced  by  the  morbid  exhalation  from  the  docks  of 

that  city.     Sporadic  cafes  of  it  occurred  likewife  in 

moft  of  the  ftates,  in  which  the  proofs  of  its  being 

generated  were  obvious  to  common  obfervationj 

and  where  the  fymptoms  of  deprelTed  pulfe,  yellow- 

nefs  of  the  fkin,  and  black  difcharges  from  the  bowels 

and   ftomach  (fymptoms  which  mark    the  higheil 

grade  of  bilious  remitting  fever)  did  not  occur,  the 

fevers  in  all  their  forms  of  tertian,  quotidian,  colic, 

and  dyfentery,  were  uncommonly  obftinate,  or  fatal 

in  every  ftate  in  the  Union.     In  New  Haven  only 

where  the  yellow  fever  was  epidemic,  it  was  faid  to 

have  been  imported  from  Martinique.     It  is  poiiiblc 

this  was  the  cafe,  but  I  fufpe£l:  that  this  fever  has 

often  been  afcribed  to  importation,  from  the  circum- 

ftance 


BILIOUS    YELLOW    FEVER,    IN    1 794.  69 

ftance  of  its  appearing  firll:  on  board  of  ihips,  and 
among  failors  who  have  juft  arrived  from  Wefl  India 
voyages,  into  whom  the  feeds  of  the  fever  are  often 
conveyed  by  the  proximity  of  the  fliips  to  filthy 
wharves  and  docks,  and  in  whom  they  are  after* 
wards  excited  into  adlion  by  hard  labour  or  intem- 
perance.  But  where  this  is  not  the  cafe,  I  beheve 
the  difeafe  is  fometimes  excited  by  the  effluvia  of 
fuch  parts  of  the  cargoes  of  fliips  as  are  capable  of 
putrefa£i:ion,  and  whidi  a£l:  witli  morbid  force  as 
ibon  as  they  are  brought  into  conta^  with  the  ain 
A  folitary  inftance  of  a  fever  which  terminated  ftfe- 
tally,  occurred  in  this  city  a  few  years  ago,  froia 
the  fmell  of  wine,  which  had  become  putrid  in  the 
hold  of  a  fliip,  but  which  was  inoffeniive  uBtil  it  was 
removed. 

For  a  while  I  believed  that  I  w«ls  the  €rft  perlbii 
who  had  aiTerted  that  a  yellow  fever  had  been  ge- 
nerated in  Philadelphia  ;  but  my  friend  Mr.  Samuel 
Coates,  lately  put  into  my  hands  a  clinical  le£lure 
delivered  in  the  Pennfylvania  Hofpital  by  the  late 
Dr.  Thomas  Bond,  on  the  3d  of  December  1766, 
and  which  was  preferved  by  order  of  the  managers 
in  the  third  volume  of  their  Minutes,  in  which  the 
Doctor  fays  that  he  had  feen  the  yellow  fever  five 
times^  in  Philadelphia.  The  fecond  time  he  faw 
it,    it    was    indlgenoMSy    from  evident  caufes,  and 

E  3  was 


70  AN    ACCOUNT    OF    THE 

was  confined  to  one  fquare  of  the  city.  The  loca- 
lity of  this  fever  defignates  its  putrid  origin,  and 
bilious  character.  BiUous  fevers  of  all  degrees  are 
often  limited  in  their  progrefs  by  winds,  trees,  hills, 
houfes,  and  other  circumftances.  Dr.  Bond  men- 
Jtions  in  the  fame  ledure  that  an  intermittent  pre- 
vailed in  the  year  1765  from  the  fouthern  parts  of 
Philadelphia  to  Georgia,  affefting  two-thirds  of  all 
the  inhabitants  in  that  extenfive  tra6l  of  country  ; 
and  yet  at  this  time  the  city  of  Philadelphia,  except 
its  fouthern  fuburbs,  was  healthy.  The  break-bone, 
or  bilious  fever  of  1780,  was  confined  chiefly  to 
the  eallern  and  fouthern  flreets  of  Philadelphia. 

;  The  year  1795  furnifhed  fever al  melancholy 
proofs  of  the  American  origin  of  the  yellow  fever. 
All  the  Phyficians  and  citizens  of  New- York  and 
Norfolk  agree  in  its  having  been  generated  in  their 
refpe£live  cities  laft  year.  It  prevailed  with  great 
mortality  at  the  fame  time  in  the  neighbourhood 
of  the  Lakes,  and  on  the  waters  of  the  Genefee 
river  in  the  flate  of  New- York,  From  its  fituation 
it  obtained  the  name  of  the  Lake  and  Genefee  fever. 
It  was  fo  malignant  in  fome  parts  of  that  new  coun- 
try as  to  afte£l  horfes, 

I  have  been  frequently  rebuked  by  my  friends  for 
my  attempts  to  prove  that  the  yellow  fever  is  one 

of 


BILIOUS  TELLOW    FEVER,    IN    1794,  Jl 

t>f  the  indigenous  difeafes  of  our  country,  inafmuch 
as  the  opinion  expofed  me  to  much  unnecefTary  per- 
fecution,  and  thereby  created  an  oppofition  to  the 
remedies  I  had  ufed  and  recommended  for  the  cure 
of  that  diforder.  I  have  conflantly  anfwered  thefe 
rcmonllrances  by  declaring  the  eflabhfliment  of  my 
opinion  to  be  deeply  interefling  to  mankind,  and 
particularly  to  the  inhabitants  of  the  United  States, 
where  an  idea  that  the  yellow  fever  could  exift 
among  us  only  by  importation  has,  until  lately,  very 
generally  prevailed. 

Climates  and  feafons  are  not  necefTarily  fickiy. 
The  fun  would  feldom  fmite  by  day,  nor  the  moon  by 
night,  were  pains  taken  to  prevent  the  accumula- 
tion and  putrefaiftion  of  thofe  matters  which  occa- 
fion  malignant  bilious  fevers.  Thofe  parts  of  the 
Weft  India  iflands  which  are  removed  from  the 
neighbourhood  of  marfh  exhalations,  are  uncom- 
monly healthy.  Of  this  Dr.  Lind  has  given  us 
many  flriking  inflances.  Dr.  Chilliolm  has  lately 
added  his  teftimony  to  the  truth  of  the  fame  obfer- 
vation.  *  It  is  further  confirmed  by  the  following 
extract  of  a  letter  from  Dr.  Davidfon,  dated  No- 
vember 1 2th,  1794.  "  I  have  mentioned  an  in- 
ftance  (fays  the  Doctor)  of  the  remarkable  good 

*  IntroJadicTi,  p.  30. 

E  4  ftate 


Jl^  i^N    ACCOUNT    OF    THE 

ftate  of  health  which  the  66th  regiment  enjoyed  at 
St.  Vincents  for  feveral  years,  upon  a  high  hill 
above  the  town,  removed  from  all  exhalations,  and 
in  a  fituation  kept  at  all  times  cool  by  the  blowing 
of  a  conflant  trade  wind.  They  did  noi  lofe  du- 
ring eighteen  months  above  tw^o  or  three  men  (the 
regiment  was  completed  to  the  peace  ellablifliment), 
and  during  eight  years,  they  loft  only  two  officers, 
one-  of  whom,  the  quarter  mafter,  refided  conftantly 
in  town,  and  died  from  over  fatigue  ;  the  other  ar- 
rived very  ill  from  Antigua,  and  died  within  a  few 
days  afterwards."  But  this  is  not  all.  There  are 
many  proofs  that  uncommon  degrees  of  longevity 
as-  well  as  health,  are  to  be  met  with  in  all  the  Weft 
India  Iflands. 

Thefe  fa^ts  are  important,  inafmuch  as  they 
mcMiifeft  the  goodnefs  of  Heaven  in  having  furren* 
dered  every  part  of  the  globe  to  man  in  a  ftate  ca- 
pable of  being  inhabited  and  enjoyed.  They  fliew 
moreover  the  connexion  between  health  and  lono^e- 
vity,  and  the-reafon  and  labour  of  man. 

Under  the  impreiTion  of  this  fentiment,  it  would 
be  criminal  in  me  to  ceafe  to  propagate  the  opinion 
of  the  domeftic  origin  of  the  yellow  fever.  It  leads 
to  the  annihilation  of  more  human  mifery  than  is 
produced  by    war  or  famine.      From   the  fuccefs 

which 


BILIOUtif    YELLOW    FEVER,    IN     1 794.  73 

which  has  attended  perreycrance  in  inculcating  opi- 
nions equally  odious  and  unpopular,  I  am  fatisfied 
that  truth,  upon  this  fubje6i:,  mujl:  prevail,  and  that 
I  fhall  fooner  or  later  be  believed  and  forgiven. 

To  every  natural  evil  Heaven  has  difcovered  or 
prepared  an  antidote.  The  yellow  fever  furniilies 
no  exception  to  this  remark.  The  means  of  pre- 
venting it  are  as  much  under  the  power  of  human 
reafon  and  induflry,  as  the  means  of  preventing  the 
evils  of  lightning  and  common  fire.  I  am  fo  fatis- 
fied of  the  truth  of  this  opinion,  that  I  look  for  a 
time,  when  our  courts  of  law  fhall  punifli  cities  and 
villages  for  permitting  a  fingle  cafe  of  bilious  or  yel- 
low fever  to  exifl  within  their  jurifdivHiion. 

I  ftiall  conclude  this  account  of  the  origin  of  the 
yellow  fever  by  relating  a  fa6t  which  ferious  and 
contemplating  minds  will  apply  to  a  more  interefling 
fubje^l. 

Notwithfianding  the  numerous  proofs  of  the  pre- 
valence of  the  yellow  fever  in  Philadelphia  in  the 
year  1794  which  have  been  mentioned,  there  are 
many  thoufands  of  our  citizens,  and  a  majority  of 
our  phyficians,  who  do  not  believe  that  a  cafe  of  it 
exifled  at  that  time  in  the  city  ;  nor  is  a  fmgle  re- 
cord of  it  to  be  met  with  in  any  of  the  newfpapers, 

or 


74  AN    ACCOUNT    OF    THE 

or  Other  public  documents  of  that  year.  Let  us 
learn  from  this  fa£^,  that  thq  denial  of  events,  or  a 
general  filence  upon  the  fubje£t  of  themj  is  no  refu- 
tation of  their  truth,  where  they  oppofc  the  pride 
or  interefls  of  the  learned  or  the  great. 

What  the  exa^fi:  flate  of  the  atmofpherc  is,  which 
difpofes  to  malignant  fevers,  is  difficult  to  determine. 
Two  things  are  obvious  with  refpe£i:  to  it.  i.  It 
pervades  at  the  fame  time  a  great  extent  of  coun- 
try. This  was  evident  in  the  years  1793  and  1794 
in  the  United  States,  During  the  fame  year  the 
yellow  fever  was  epidemic  in  mofl  of  the  Weil  In- 
dia iflands.  Many  of  the  epidemics  mentioned  by 
Dr.  Sims  *  aifedled  in  the  fame  years  the  moft  re- 
mote parts  of  the  continent  of  Europe.  Even  the 
ocean  partakes  of  a  morbid  conflitution  in  its  atmo- 
fphere,  and  difeafes  at  fea,  fympathife  in  violence 
with  thofe  of  the  land,  at  an  immenfe  diflance  from 
each  other.  This  appears  in  a  letter  from  a  furgeon 
on  board  a  Britifh  lliip  of  war  to  Mr  Gooch,  pub- 
liflied  in  the  third  volume  of  his  medical  and  furgical 
obfervations.  2.  This  predifpofmg  flate  of  the  at- 
mofphere  to  induce  malignant  difeafes  continues  for 
fevera.1  years,  under  ail  the  circumflances  of  wet 
and  dry,  and  of  hot  and  cold  weather. 

*  Medical  Memoirs,  Vol.  I. 

The 


BILIOUS    YELLOW    FEVER,    IN    1794.  "/S 

The  weather  in  1794  diiFered  materially  from 
the  weather  in  1793,  in  the  United  States,  in  each 
of  the  above  particulars ;  and  yet  the  atmofphere 
continued  to  maintain  that  quality  which  predifpofes 
to  a  malignant  flate  of  bilious  fever. 

This  morbid  peculiarity  in  the  air  is  taken  notice 
of  by  Dr.  Sydenham,  and  acknowledged  by  him  as 
an  obfcure  circumflance  in  the  hiflory  of  epidemics. 
It  refembles  a  folitary  fever  and  a  general  epide- 
mic, in  beginning  with  violence,  and  gradually  wail- 
ing its  inflammatory  force  by  time.  To  what  change 
in  the  ftate  of  the  air,  or  to  what  impregnation  of 
it,  fliall  we  attribute  its  difpofition  to  impart  a 
greater  degree  of  malignity  or  inflammatory  diathefis 
to  difeafes  at  one  time  than  at  another  ?  Hippocrates, 
who  felt  the  influence  of  this  diathefis  in  his  prac- 
tice, afcribes  it  to  "  a  divine  fomething"  in  the  at- 
mofphere. Dr.  Sydenham  attributes  it  to  certain 
mineral  vapours  exhaled  from  the  bowels  of  the 
earth.  I  have  fufpe6led  it  to  be  the  efre6i:  of  a  pre- 
ternatural quantity  of  oxygen  in  the  atmofphere.  I 
know  that  the  experiments  of  Mr.  Sheele  and  Mr. 
Cavendifh  prove  that  the  proportions  of  azote  and 
oxygen  are  the  fame  in  different  fituations  and  dif- 
ferent kinds  of  weather ;  but  as  their  experiments 
were  not  made  at  a  time  Vv'hen  difeafes  of  a  high 
degree  of  inflamm.atory  a<5i:ion  were  epidemic,  1  do 

not 


"J^S  AN    ACCOUNT    OF    THE 

not  think  they  mihtate  againfl:  my  hypothefis.  I 
lament  that  the  want  of  eudiometrical  inflruments 
prevented  my  deciding  this  queilion  by  aftual  expe- 
riments, during  the  prevalence  of  our  late  inflamma- 
tory epidemics ;  but  the  following  fa<^s  will,  I 
hope,  render  the  hypothecs  probable,  i.  The  dif- 
eafe  was  moil  violent  in  thofe  perfons  in  whom  there 
is  fuppofed  to  be  the  greateil  quantity  of  oxygen, 
viz.  the  young  and  the  robuft,  and  more  efpecially 
thofe  who  live  freely.  2.  It  alFefted  thofe  perfons 
mod  violently  who  had  lately  arrived  from  places 
or  fituations  in  which  oxygen  abounded.  Country 
people  fulfered  more,  under  equal  circnmftanccs, 
from  the  fever,  than  the  citizens  of  Philadelphia ; 
but  it  was  mofl  violent  in  perfons  who,  after  fpend- 
ing  four  or  five  w^eeks  at  the  fea-fliore,  returned  to 
the  city  in  the  months  of  September  and  October. 
This  was  the  cafe  with  Peter  Brown  and  Henry 
Clymer,  who  fickened  foon  after  they  inh"aled  the 
atmofphere  of  our  city,  and  were  both  afFe^l-ed  by 
the  fever  in  a  very  high  degree.  I  fliould  have 
fufpedted  that  the  uncommon  malignity  of  the  dif- 
eafe  in  thofe  two  gentlemen  arofe  from  the  indo- 
lence and  plentiful  diet  which  conftitute  part  of  the 
pleafure  of  an  excurfion  to  the  fea-ihore,  hud  I  not 
met  with  feveral  cafes  of  equal  violence  in  perfons 
who  had  jufl  arrived  from  fea  voyages,  under  cir- 
cumilances  by  no  means  apt  to  produce  inflammable 

diathefi5 


Bilious  yellow  fever,  in    1794.        77 

diathefis  in  the  blood-vefTels.  3.  The  colour  of  the 
blood  in  moll  cafes  of  yellow  fever,  as  I  fliall  lay 
hereafter,  was  fuch  as  is  imparted  by  oxygen.  It  is 
pofTible  the  air  may  communicate  as  much  oxygen 
to  the  blood,  as  is  fufEcient  to  produce  a  predifpo- 
fition  to  inflammatory  difeafes,  and  yet  rcfufc  to  dif- 
cover  itfelf  in  an  undue  quantity  to  an  eudiometri- 
cal  experiment ;  for  Dr.  Beddoes,  to  whofe  autho- 
rity upon  this  fubjci^  I  yield  my  judgment,  fays, 
and  I  believe  very  juftly,  in  a  letter  I  received  from 
him,  dated  May  3d,  1795,  that  "  he  has  no  doubt, 
but  a  fmall  excefs  of  oxygen  is  equal  to  the  produc- 
tion of  highly  inflammatory  action." 

If  it  fliould  be  found  hereafter,  that  no  excefs 
in  the  quantity  of  oxygen  in  the  atmofphere  takes 
place  during  the  prevalence  of  malignant  fevers,  I 
fhall  flill  fufpedl  it  to  be  their  predifpofmg  caufe, 
and  that  it  may  pofllbly  be  derived  from  the  ali- 
ments and  fruits  of  the  feafon  ;  for  all  writers  take 
notice  of  a  conneflion  between  great  and  mortal 
epidemics^  and  a  deviation  in  quality  or  quantity 
from  common  years  in  the  vegetable  produfls  of  the 
earth. 

The  exhalations  or  gafes,  which  by  ailing  upon 
an    inflammatory  predifpofltion  produce    a  yellow 
fever^  have  been  called  by  different  names,  accord- 
ing 


7$  AN    ACCOUNT    OF    TH£ 

ing  as  they  a£l  in  a  flmple  or  compound  Hate.  They 
all  a£l  as  ftimulants  upon  the  whole  fyftem,  and  in 
a  more  efpecial  manner  upon  the  liver.  This  is  evi- 
dent, not  only  in  the  affections  of  that  vifcus  in 
bilious  fevers,  but  in  the  morbid  appearances  of  the 
liver  in  cattle  that  feed  in  marfliy  paflure  in  the  fall 
of  the  year.  Thefe  appearances  were  fo  univerfally 
admitted  to  be  the  effect  of  an  unwholefome  atmo- 
fphere  among  the  ancients,  that  they  infpe<fted  the 
livers  of  animals,  in  order  to  determine  on  the 
healthy  or  unhealthy  fituation  of  the  fpots  on  which 
they  willied  to  live. 

Dr.  Cleghorn  defcribes  a  morbid  ftate  of  the 
liver  in  cattle  in  an  unhealthy  part  of  the  ifland  of 
Minorca.  Dr.  Grainger  takes  notice  of  the  fame  ap-^ 
pearances  in  the  livers  of  feveral  domellic  animals  in 
Holland,  in  the  year  1743.  *  But  our  own  country 
has  furniflied  fafts  to  illuflrate  the  truth  of  this  ob' 
fervation.  Mr.  James  Wardrobe,  near  Richmond 
in  Virginia,  informed  me,  that  in  the  month  of  Au- 
guil  1794,  at  a  time  when  bilious  fevers  were  pre- 
valent in  the  neighbourhood,  his  cattle  were  feized 
with  a  difeafe  which  is  known  by  the  name  of  the 
yellow  water,  and  which  appears  to  be  a  true  yel- 
low fever.     They  were  attacked  with  a  flaggering. 


Cap.  lU. 

Their 


BILIOUS    YELLOW    FEVER,    IM    1 794.  79 

Their  eyes  were  muddy  or  ferocious  :  a  conivenefs 
attended  in  all  cafes.  It  killed  in  two  days.  Fifty- 
two  of  his  cattle  perifhed  by  it.  Upon  opening  fe- 
veral  of  their  dead  bodies,  he  found  the  liver  fwell- 
ed  and  ulcerated.  The  blood  was  dilTolved  in  the 
veins.  In  the  bladder  of  one  of  them  he  found 
thirteen  pints  of  blood  and  water.  Curiofity  led 
him  to  inoculate  two  of  his  calves  from  the  blood 
of  a  difeafed  animaL  They  both  fickened  in  eight 
days,  and  after  being  lightly  indifpofed,  they  both 
recovered. 

I  have  avoided  deciding  lipon  the  fpecific  nature 
of  the  exhalations  which  induce  difeafes  :  This  fub- 
je6t  has  been  purfued  with  great  ardor  by  Profeflbr 
Mitchell  of  New- York.  His  accurate  knowledge  of 
the  laws  of  the  animal  economy,  added  to  the  re- 
cords of  the  late  unfuccefsful  application  of  the  prin- 
ciples of  ele£lricity  and  fixed  air  to  medicine,  will,  I 
hope,  defend  him  from  an  undue  application  of  his 
ingenious  difeoveries  to  the  theory  and  practice  of 
phyfic. 

It  is  no  obje£lion  to  the  influence  of  thefe  exhala- 
tions in  difordering  the  liver,  that  the  cattle  killed 
and  fold  in  the  Philadelphia  market  in  the  autumns  of 
1793  and  1794  exhibited,  in  only  one  inilance  that 
has  come  to  my  knowledge^  the  leaft  mark  of  dif- 

eafe  ; 


Bo  AN    ACCOUNT    OF    THE 

eafe ;  for  tliofe  cattle  fed  in  paflures  previoully  to 
their  being  killed,  in  which  no  exhalation  took 
place.  This  was  evident  from  the  uncommon  healthi- 
nefs  of  the  people  in  that  part  of  the  neighbour- 
hood of  the  city,  from  whence  the  cattle  were 
brought  a  day  or  two  before  they  were  killed*    . 

Thus  I  have  endeavoured  to  fix  the  predifpofnig 
and  remote  caufes  of  the  yellow  fever  in  our  coun- 
try. The  remote  caufe  is  fometimes  fo  powerfuJ, 
as  to  become  an  exciting  caufe  of  the  difeafe ;  but 
in  general,  both  the  predifpofmg  and  remote  caufes 
are  harmlefs  in  the  fyilem,  until  they  are  roiifed  into 
action  by  fome  exciting  caufe. 

Before  I  proceed  to  mention  the  remedies  which 
were  ufed  in  the  cure  of  the  fever  which  has  been 
defcribed,  I  fiiall  fubjoin  fcales  of  the  relative  conta- 
gious nature,  of  the  diflance  of  infefbion,  and  of  the 
mortality  of  the  moH  com.mon  contagious  fevers, 
beginning  with  thofe  which  predominate  under  each 
head. 

L 

A  fcale  of  the  extent  or  univerfality  of  contagious 
fevers. 

I.  Small-pox* 
2  Meafles. 

4  3-^1^- 


BILIOUS    YELLOW    FEVER,    IN    I794.  Si 

3.  Influenza. 

4.  Plague. 

5.  Bilious  fever  in  the  form  of  yellow  fever 
in  certain  feafons  and  places. 

6.  Cynanche  fcarlatina. 

7.  Cynanche  maligna. 

8.  The  dyfentery. 

9.  The  common  bilious  remitting  fever. 
1  o.  The  common  intermitting  fever. 

The  influence  of  climate^  weather  and  habit  of 
body,  fometimes  vary  this  fcale,  but  the  relative 
order  in  which  the  above  fevers  aife^l  a  greater  or 
lefs  number  of  people,  I  believe  in  common  years, 
and  in  moll  countries,  accords  with  the  obfervations 
of  moil  phyficianS. 

11, 

Scale  of  the  relative  dijlance  at  which  contagious^ 
fevers  propagate  themfelves,  : 

I.  Small-pox* 

1,  Meafles. 

3»  Influenza. 

4.  Yellow  fever. 

5.  Plague. 

6.  Jail  fever. 

7.  Cynanche  maligna* 

VOL.  iv«  F  8.  Cynan- 


Si  AN   ACCOUNT    OP    TH'g  ^ 

8.  Cynanche  fcarlatina. 

9.  Dyfentery. 

I  o.  The  common  intermitting  fever. 

^  III.  - 

Scale  of  the   relative    mortality   of   contagious 
difeafes. 

1.  The  plague-  . 

2.  The  yellow  fever. 

3.  The  jail  fever; 

4.  The  cynanche  maligna. 

5.  The  dyfentery. 

6.  The  natural  fmajl-pox. 

7.  The  cynanche  fcarlatina. 

8.  The  influenza  and  mealies. 

9.  The  common  bilious  fever. 

I  o.  The  common  intermitting  fever. 

The  above  fcale  reprefents  the  relative  order  of 
contagious  fevers  when  left  to  themfelves.  DiiFe- 
rence  of  climate,  feafon,  habit  of  body,  ?ind  above 
all,  difference  of  treatment  greatly  vary  their  re- 
lative mortality.  For  example,  in  Jamaica  a  fourth 
and  in  St.  Domingo  one  half  fometimes  die  of  the 
yellow  fever  who  take  bark  and  wine,  whereas  in 
Philadelphia  the  mortality,  as  will  be  fliewn  here- 
after does  not  exceed  more  than  one  in  fifty,  where 
depleting  remedies  are  ufed  in  their  proper  extent. 

Methoe 


BiLIOtm  YELLCrW    FEVER,    IN    I794.  83 


/:,?::.D::i:'i 


Of  the  JMtethod  of  Cure. 


A  HE  remedies  employed  for  the  cure 
of  this  fever,  were  the  fame  that  I  employed  the 
year  before.  I  fliall  only  relate  itich  effe(fts  of  them 
as  tend  more  fully  to  eftablifli  the  pfaftice  adopted 
in  the  year  1793,  and  fuch  as  efcaped  my  notice  in 
my  former  obfervatibns  upon  thofe  remedies.  My 
method  of  cure  cbnfifted  '"^^  "^^: 

I.  In  the  abfl:ra£lion  of  the  ftimulus  of  blood,  and 
heat  from  the  whole  body,  and  of  bile,  and  othef 
acrid  humors  from  the  bowels,  by  means  of  the  fol- 
lowing remedies ; 

1.  Bleedings 

2.  Purging.- _o*  iu.a  \ 

3.  Cool  air,  and  cold  drinks^ 

4.  Cold  water  applied  to  the  external  parts 
of  the  body,  and  to  the  bowels  by  means  of 

<  glyfters.  '  -^ 


84  AN   ACCOtJNT   OF   rat 

II.  In  creating  a  diverfion  of  congellion,  inflam- 
mation, and  ferous  efFufion,  from  the  brain  and  vif- 
cera  to  the  mouth,  by  means  of  a  falivation,  and 
to  the  external  parts  of  the  body,  by  means  of 
bliflers. 

in.  In  reflcHring  the  ftrength  of  the  fyflem,  by 
tonic  remedies.  > 

I  proceed  to  make  a  few  remarks  upon  the  reme- 
dies fet  down  under  each  of  the  above  heads. 

I.     Q  F    B  L  E  E  D  I  N  G, 

X  HAVE  taken  noti66  that  this  fever  dif- 
fered from  the  fever  of  1793,  incoming  forward 
in  July  ancf  Auguft  with  a  number  of  paroxyfms, 
which  reiufed  to  yield  to  purging  alone.  I  there- 
fore began  the  curt  of  every  cafe  I  was  called  to  by 
bleeding. 

I  fliall  mention  the  eife^s  of  this  remedy,  and  the 
circumflanccs,  manner,  and  degrees  in  whith  I  ufed 
it  OGcafionally,  in  this  fever,  iamy  defence  of  blood- 
letting. Under  the-prefent  head  I  fliall  only  fur- 
nifh  the  reader  with  a  table  of  the  quantity  of  blood 

drawi^ 


BILIOUS   ¥^LL@W    PV^^,   I^    1794-  ^5 

drawn  £r€?miL  anmfe^r  ©f  pf  patiefit^  in  the  cpurfe 
of  th|B  difefife.  From  ffeyer^,!  of  them  th^  quantity 
fet  dawn,  wg8  ukm  ia  ttir^e,  four,  itjii  ivf  days. 
I  idiall  afterw«^r4§  4?i&ribe  \k^  appigftrascf ^  f f  tfe^ 
blood. 


Month. 

Patients. 

^laritity  ' 
ounces. 

50 

Number  of 
times  bled. 

Augufl. 

Peter  Denhani. 

5 

Mrs.  Bruce. 

70 

7 

Andrew  Gribble 

aged  1 5  years. 
John  Madge. 
Peter  Brown. 

50 

150 

80 

5 

12 

8 

September. 

Mrs.  Gardiner. 
Mifs  Sally  gyre. 
Mrs.  Gafs.  ^ 

80 

59 

7 
9 
3 

Richard  W^ls's 

maid. 

i  00 

10 

Mr.  Nerval. 

ICO 

9 

Mr.  Harrifon. 

90 

9 

Ociober. 

Henry  Clymer. 
Mrs.  Mitchell. 

80 
120 

8 
^3 

-  ■ 

Mrs.  Lenox. 

80 

7 

Mrs.  Kapper. 
ReVcDr.Magaw^s 
maid. 

140 

100 

II 

10 

Mifs  Hood. 

100 

10 

Mrs.  Vogles. 

70 

5 

1795 
January. 

Guy  Stone. 
Benj.  Hancock. 
Mr.  Benton. 

100 
100 

9 
10 

13 

Mrs.  Fries. 

150 

15 

Mrs.  Garrigues, 

80 

7 

F3 


Three 


B6''        •    .    AN  AeeouNT  of  the      "^^ra 

:/ Three  of  the  women  whofe  names- 1  have  men- 
tioned, were  in  the  advanced  flage  of  pregnancy, 
viz.  Mrs.  Gardiner,  Mrs.  Gafs,  and  Mrs.  Garrigues. 
They  have  all  fmce  borne  healthy  children.  I  have 
omitted  the  names  of  above  one  hundred  perfons 
who  had  the  fever,  from  whom  I  drew  thirty  or 
forty  ounces  of  blood  by  two  or  three  bleedings^ 
I  did  not  cure  a  fingle  perfon  without  at  leafl  one 
bleeding.  . 

■   -  -    -  rf 

It  is  only  by  contemplating  the  extent  in  which 
it  is  neceiFary  to  ufe  this  remedy,  in  order  to  over* 
come  a  yellow  fever,  that  we  can  acquire  jufl  ideas 
of  its  force.  Hitherto  this  force  has  been  eftimated 
by  no  other  meafure  than  the  grave,  :^nd  this  we 
know  puts  the  {Irength  of  all  difeafes  upon  a  leveL    . 


The  blood  drawn  in  this  fever  exhibited  the  toU 
lowing  appearances. 

1.  It  was  difTolved  in  a  few  inftances. 

2.  The  craffamentum  of  the  blood  was  fo  partially 
difTolved  in  the  ferum  as  to  produce  an  appearance 
in  the  ferum  refembling  the  walhings  of  jfjefh  in 
water. 

3.  The  ferum  was  fo  lightly  tinged  of  a  r^d 
colour  as  to  be  perfectly  tranfparent.  '-^'^ 

4.  The 


BILIOUS  YE-ULQW   FEVER,   IN  .  1794,  8^ 

4.  Theferum  was  in  many  cafes  of  a  deep  yellow. 
colour. 


5.  Thore  was  in  every  cafe  in  which  the  blaod 
was  not  diifolved,  or  in  which  the  fecond  appearance 
thatiias  been  mentioned  did  not  take  place,  a  beau-, 
tiM  fcarlet  coloured  fediment  in  the  bottom  of  the 
bowl,  forming  lines,  or  a  large  circle.  It  feemed  to 
be  a  tendency  of  the  blood  to  diiTolution.  This  flate 
of  the  blood  occurred  in  almofl  all  the  difeafes  of  the 
lafl  two  years,  and  in  fome  in  which  there  was  not 
the  leafl  fufpicion  of  the  miafmata  or  contagion  of 
the  yellow  fqven 

6.  The  craffamentum  generally  floated  in  the 
ferum,  but  it  fometimes  funk  to  the  bottom  of  the 
bowl.  In  the  latter  cafCj  the  ferum  had  a  muddy 
appearance. 

7.  I  faw  but  one  cafe  in  which  there  was  not  a 
feparation  of  the  craflamentum  and  ferum  of  the 
blood.  Its  colour  in  this  cafe  was  of  a  deep  fcarlet. 
In  the  year  1793  this  appearance  was  very  common, 

8.  I  fav/  one  cafe  in  which  the  blood  drawn, 
amounting  to  14  ounces,  feparated  partially,  and  was 
of  a  deep  black  colour.  This  blood  was  taken  from 
Mr.  Norval  a  citizen  of  North  Carolina,  who  had 

-        ,  F  4  been 


B^  AN    ACCOUNT    OF    THS 

been  infc6led  with  the  fever  by  fleeping  in  the  fame 
Toom  with  Mr.  Harrifon,  a  citizen  of  Virginia. 

9.  There  was  in  feveral  inftances  a  tranfparent 
felly-like  pellicle  which  covered  the  craffamentum 
of  the  blood,  and  which  was  eafily  feparated  from 
it,  without  altering  its  texture.  It  appeared  to  have 
no  connection  with  the  blood. 

10.  The  blood  towards  the  crilis  of  the  fever  ia 
many  people  exhibited  the  ufual  forms  of  inflam- 
matory cruft.     It  was  cupped  in  many  inftances. 

11.  After  the  lofs  of  70  or  80  ounces  of  blood, 
there  was  an  evident  difproportion  of  the  quantity 
of  craiTamentum  to  the  ferum.  It  was  fometimes  lefs 
hy  one  half,  than  in  the  firll  bleedings. 

Under  this  head,  it  will  be  proper  to  mention 
that  the  blood  when  it  happened  to  flow  along  ths 
external  part  of  the  arm  in  falling  into  the  bowl, 
was  fo  warm  as  to  excite  an  unpleafant  fenfation  of 
heat  in  feveral  patients. 

To  the  appearances  exhibited  by  the  blood  to  the 
eye,  I  fhall  add  a  fa6l  communicated  to  me  by  a 
German  bleeder  who  followed  his  bufmefs  in  the 
city  during  the  prevalence  of  the  fever  in   1793. 

He 


BILIOUS    YELLOW    FEVER,    IN    1 794.  89 

He  informed  me  that  he  could  diftinguifli  a  yellow 
fever  from  all  other  flates  of  fever,  by  a  peculiar 
fmeli  which  the  blood  emitted  while  it  was  flowing 
from  a  vein.  From  the  certainty  of  his  decifion  in 
one  cafe  which  came  under  my  notice,  before  a  fuf- 
picion  had  taken  place  of  the  fever  being  in  the 
city,  I  am  difpofed  to  beHeve  that  there  is  a  founda- 
tion for  his  remark. 


2.     OF    PURGING. 


I 


HAVE  but  little  to  add  under  this  head 
to  the  obfervations  that  I  have  made  upon  this  re- 
medy in  the  year  1793.  I  purged  with  jalap,  calo- 
mel, and  gamboge  until  I  obtained  large  and  dark-cc- 
loured  flools ;  after  wlifch  I  kept  the  bowels  gentlj 
open  every  day  with  cailor  oil,  cremor  tartar,  or 
Glauber  falts.  I  gave  calomel  in  much  larger  quan- 
tities that  I  did  the  year  before.  John  Madge  took 
nearly  150  grains  of  it  in  fix  days.  I  iliould  have 
thought  this  a  large  quantity,  had  I  not  fnice  read 
that  Dr.  Chifliolm  gave  400  grains  of  it  to  one 
patient  in  the  courfe  of  his  fever,  and  50  grains  to 
another  at  a  fmgle  dofe,  three  times  a-day.  I  found 
flrong  mercurial  purges  to  be  extremely  ufeful  in 

the 


90-  an:  account  of  tnz    . 

the  winter  months,  when  the  fever  put  on  fymp- 
toms  of  pleurify.  I  am  not  fmgular  in  afcribing:i 
much  to  the  efEcacy  of  purges  in  the  bilious  pleu- 
rify. Dr.  Defportes  tells  us,  that  he  found  the: 
pleurify  of  St.  Domingo,  which  was  of  the  bilious 
kind,  to  end  happily  in  proportion  as  the  bowels 
were  kept  conftantly  open,  *  Nor  am  I  fmgular  in 
keeping  my  eye  upon  the  original  type  of  a  difeafe, 
which  only  changes  its  fymptoms  with  the  weather 
or  the  feafon,  and  in  treating  it  with  the  fame  re- 
nledies.  Dr.  Sydenham  bled  as  freely  in  the  diar- 
rhoea of  1668,  as  he  had  done  in  the  inflammatory 
fever  of  the  preceding  year,  f  How  long  the  pleu- 
rifies  of  winter,  in  the  city  of  Philadelphia,  may  con- 
tinue to  retain  the  bilious  fym.ptoms  of  autumn, 
which  they  have  aflumed  for  three  years  pad,  I 
know  not ;  but  the  late  Dr.  Fayfleaux  of  South 
Carolina  informed  me,  that  for  many  years  he  had 
not  feen  a  pleurify  in  Charlefton  with  the  common 
inflammatory  fymptoms  which  chara<!lerized  that  dif- 
order^  v/hen  he  v\^as  a  ftudent  of  medicine.  They 
all  now  put  on  bilious  fymptoms,  and  require  flrong 
purges  to  cure  them*  The  pleurifies  which  the  late 
Dr.  Chalmers  fuppofes  he  cured  by  purging,  were 
probably  nothing  but  bilious  fevers,  in  which  the 
ciool  w:eather  had  excited  fome  pleuritic  fymptoms. 

*  ?.   140.  t  Wallis*s. edition,  p.  211.  Vol.  I. 

3-1 


BILIOUS   YELLOW   FEVEJR,    IN    1794.  51: 

3.  1  have  nothing  to  add  to  the  obfervatlons  I^ 
have  elfewhere  piibhflied  upon  the  efficacy  of  cool 
air  and  cold  drinks  in  this  fever.  They  were  both 
equally  pleafant  and  ufeful^  and  contributed,  with, 

cleanlinefs,  very  much  to  the  fuccefs  of  my  pra£iice. 

-     .  -  ■    ,  -  I- 

4.  Cold  water  applied  to  the  external  parts  of  the 
body,  and  inje^ed  into  the  bowels  by  way  of  gly« 
fter,  did  great  fervice  in  many  cafes.  John  Madge 
found  great  relief  from  cloths  dipped  in  cold  wa- 
ter and  applied  to  the  lower  part  of  his  belly.  They 
eafed  a  pain  in  his  bowels,  and  procured  a  dif- 
charge  of  urine.  A  throbbing  and  moft  diftreffing 
pain  in  the  head,  was  relieved  by  the  fame  remedy 
inMrs.  Vogles  and  Mrs.  Lenox.  The  cloths  were 
applied  for  three  fucceffive  days  and  nights  to  Mrs* 
Lenox's  head,  during  an  inflammation  of  her  brain,, 
which  fucceeded  her  fever,  and  were  changed 
during  the  greater  part  of  the  time,  every  ten  or 
fifteen  minutes.  In  1795  I  increafed  the  coldnefs 
of  pump  water  when  ufed  in  this  way,  by  diffolving, 
ice  in  it,  and  in  fome  cafes  I  applied  powdered  ice 
in  a  bladder  to  the  head,  with  great  advantage. 

The  following  fafts  will  fliew  the  good  elFects  of 
cold  water  in  this,  as  well  as  other  fevers  of  too 
much  action.  In  the  afternoon  of  one  of  thofe  days 
m  wliich  my  fyitem  was  impregnated  with  the  conta* 

gion 


92  AN    ACCOUNT    OF    TK5 

gion  of  the  yellow  fever,  I  felt  fo  much  indifpofed 
that  I  deliberated  whether  I  fliould  go  to  bed,  or 
viiit  a  patient  about  a  mile  in  the  country.  The 
afternoon  was  cool  and  rainy.  I  recolle6led  at  this 
time-  a  cafe  related  by  Dr.  Daignan,  a  French  phy* 
fician,  of  a  man  who  was  cured  of  the  plague  by 
being  forced  to  lie  all  night  in  an  open  field  in  a 
ihower  of  rain.  I  got  into  my  chair,  and  expofed' 
myfelf  to  the  rain.  It  v/as  extremely  grateful  to 
my  feelings.  In  two  hours  I  returned,  v/hen  to 
my  great  fatisfa^iiion  I  found  all  my  feverifli  fymp- 
toms  had  left  me,  nor  had  I  the  leafl  return  of 
them  afterwards.  Dr.  Caldwell,  who  a^ed  as  a 
furgeon  of  a  regiment  in  the  expedition  againfl  the 
infurgents  in  the  weilern  counties  of  Pennfylvania, 
furnillied  me,  in  a  letter  dated  from  Bedford,  Octo- 
ber 20th,  1794,  with  an  account  of  his  having  been 
cured  of  a  fever  by  a  more  copious  ufe  of  the  fame 
remxdy.  *^  I  w^as  (fays  the  Do^lor)  to  ufe  a  vulgar 
exprelFion,  zvei  to  the  Jkin^  and  had  no  opportunity 
of  fliifting  my  clothes  for  feveral  hours.  In  confe- 
quence  of  this  thorough  bathing,  and  my  fubfequent 
expofure  to  a  cool  air,,  I  was  relieved  from  every 
fymptom  of  indifpofition  in  a  few  hours,  and  have  en- 
joyed more  than  m^y  ufual  flock  of  health  ever  fmce.** 

The   efficacy   of  cold  water  in  preventing  and 
cunng  infiammation,  may  be  conceived  from  its  ef- 
fects 


BILIOUS    YELLOW    FEVER,    IN    1/94.  93 

£e£ts  when  ufed  with  mud  or  clay,  for  obviating  the 
pain  and  inflammation  which  arife  from  the  fling  of 
venomous  infers.  The  fame  remedy  applied  for 
half  an  hour  has  lately,  it  is  faid,  been  equally  ef- 
feflual  in  preventing  the  deleterious  effects  of  the 
bite  of  a  rattle-fnake, 

II.  The  good  eiFefts  I  had  obferved  from  a  sa- 
livation in  the  yellow  fever  of  1793,  induced  me 
to  excite  it  as  early  as  poiTibk  in  all  thofe  cafes 
which  did  not  yield  immediately  to  bleeding  and 
purging.  I  was  delighted  with  its  eire<^s  in  every 
cafe  in  which  I  ufed  it.  Thefe  effciSls  were  as  fol- 
low : 

1.  It  immediately  attra6led  and  concentrated  in 
the  mouth,  all  the  fcattered  pains  of  every  part  of 
the  body. 

2.  It  checked  a  naufea  and  vomiting. 

3.  It  gradually,  when  it  was  copious,  reduced  the 
pulfe,  and  thereby  prevented  the  neceiTity  of  further 
bleeding  fer  piirging, 

I  wifb  it  were  poiTible  to  render  the  ufe  of  this 
remedy  univerfal  in  the  treatment  of  malignant  fe- 
vers.    Dr.  Chifholm,  in  his  Account  of  the  Boul- 

lam 


54  AN    ACCi^tJNT    OP    VhE 

lam.  fever,  has  done  much  to  eflablifli  its  fafety  aiid 
efficacy.  It  is  a  rare  occurrence  for  a  patient  that 
has  been  fufficiently  bled  and  purged,  to  die  after  a 
falivation  takes  place.  The  artificial  difeafe  excited 
by  the  mercury,  fufpends  or  deftroys  difeafe  in  every 
part  of  the  body.  The  occafional  inconveniences 
which  attend  it,  are  not  to  be  named  with  its  cer^ 
tain  and  univerfal  advantages.  During  the  whole 
of  the  late  feafon  in  which  the  yellow  fever  pre* 
vailed,  I  faw  but  two  inflances  in  which  it  probably 
loofened  or  dellroyed  the  teeth.  I  am  not  fatisfied 
that  the  mercury  was  the  caufe  of  the  injury  or  lofs 
of  thofe  teeth  ;  for  who  has  not  feen  malignant  fe- 
vers terminate  in  ulcers,  which  have  ended  in  the 
crofions  of  bony  parts  of  the  body  ?  '^ 

It  has  been  juftly  remarked,  that  there  can  be 
but  one  a6i:ion  at  a  time  in  the  blood-veflels.  This 
was  frequently  illuflrated  by  the  manner  in  which 
mercury  aded  upon  the  fyflem  in  this  fever.  '  It  fel- 
dom  falivated  until  the  fever  intermitted  or  declined. 
I  faw  feveral  cafes  in  which  the  falivation  came  on 
during  the  intermiffion,  and  went  off  during  its  ex- 
acerbation ;  and  many,  in  which  there  was  no  fa- 
livation until  the  morbid  aftion  had  ceafed  altoge- 
^er  in  the  blood- veffels,  by  the  folution  of  tbefc- 
yer.  It  is  becaufe  the  aftion  of  the  veffels  in  epi- 
l(epf^  and  pulmonary  confumption  furpaifes  the,  fli- 

mulus 


BILIOUS   YELLOW    FEVER,    IN    1794.  95 

mulus  of  the  mercury,  that  it  is  fo  difficult  to  excite 
a  falivation  in  both  thofe  diforders. 

Let  not  the  advocates  for  the  healing  powers  of 
nature  complain  of  a  falivation  as  an  unnatural  re- 
medy in  fevers.  Dr.  Sydenham  fpeaks  in  high 
terms  of  it  in  the  fever  of  1670,  1671,  and  1672, 
and  fays  that  it  cured  it  when  it  was  fo  malig- 
jaant,  as  to  be  accompanied  by  purple  fpots  on  the 
body.* 

Blisters,  when  applied  at  ^  proper  t\mc<i  did  great 
fervice  in  this  fever.  This  time  was,  when  the  fe- 
ver was  fo  much  weakened  by  evacuations,  that  the 
artificial  pain  excited  by  the  flimulus  of  the  blifters 
deflroyed,  and,  like  a  conductor,  conveyed  off,  all 
the  natural  pain  of  the  body.  It  is  from  ignorance, 
or  inattention  to  the  proper  flage  of  fevers  in  which 
bliflers  have  been  applied,  that  there  have  been  fo 
many  difputes  among  phyficians  refpeiSling  their  effi- 
cacy. When  applied  in  a  flate  of  great  arterial 
adion,  they  do  harm :  When  applied  after  that  ac- 
tion has  nearly  ceafed,  they  do  little  or  no  fervice. 
I  have  caHed  the  period  in  which  blifters  are  ufefuJa 
the  blijiering  point.  In  bilious  fevers  this  point  is 
generally  circumfcribed  within  eight-and-forty  hours. 

*  Vol.  II,  p.  212, 

The 


g6  AN    ACCOUNT    OF    THE 

The  effe£^s  of  bliflers  were  as  follow  : 

1.  They  concentrated,  like  a  falivatlon,  all  the 
fcattered  pains  of  the  body,  and  thereby 

2.  Reduced  the  pulfe  in  force  and  frequency. 

3.  They  inflantly  checked  a  ilcknefs  at  the  fto- 
mach  and  vomiting. 

4.  They  often  induced  a  gentle  moiHurc  upon  the 
ikin. 

I  found  it  of  little  confequence  to  what  part  of 
the  body  the  bliflers  were  applied  ;  for  I  obferved 
a  pain  in  the  head,  and  even  delirium,  to  be  as 
fpeedily  and  certainly  cured  by  bliflers  upon  the 
Tviifls,  as  they  were  by  a  large  blifler  to  the  neck. 

III.  After  the  redu£lion  of  the  morbid  a6lion  of 
the  blood- vefTels,  by  means  of  the  remedies  which 
have  been  mentioned,  I  feldom  made  ufe  of  any 
other  tonic  than  a  nourifhing  and  gently  flimulating 
diet.  This  confifled  of  fummer  fruits,  bread  and 
milk,  chicken  broth,  the  white  meats,  eggs,  oyflers, 
and  malt  liquors,  more  efpecially  porter.  I  made 
many  attempts  to  cure  this  fever  when  it  appeared 
in  the  form  of  a  fimple  intermittent,  by  means  of 

4  BARK> 


IJ1LI0*JS    YELLOW    FEVER,    IN    1794.  97 

feARK,  without  malignant  fymptoms,  but  always, 
except  in  two  inllances,  without  fuccefs ;  and  in  them 
it  did  not  ta^^e  effeft  until  after  bleedingo     In  feve- 
ral  cafes  it  evidently  did  harm*     I  fhould  have  fuf- 
pe£led  my  judgment  in  thefe  obfervations  refpefting 
this  medicine,  had  I  not  been  aiTured  by  Dr.  Grif- 
fltts,  Dr.  Phyfick,  and  Dr.  Woodhoufe,  that  it  was 
equally    ineife£lual  in  their  pra£lice,   in  nearly  all 
the  cafes  in  which  they  gave  it,  and  even  where 
blood-letting  had  been  premifed.     Dr.  Woodhoufe 
faw  a   cafe  in  which  near  a  pound   of  bark  had 
been  taken  without  effe61: ;  and  another,  in  which 
a  fatal  dropfy  fucceeded  its  ufe»     Dr.  Griffitts  ex- 
cepted from  his  teflim.ony  againfl  the  bark,  the  cafes 
of  feven  perfons    from  the  country,  who  brought 
the  feeds  of  the    intermitting  fever  with  them  to 
the  city.      In  them,    the  bark    fucceeded  without 
previous  bleeding.     The  facility  v/ith  which  thefe 
feven  cafes  of  intermitting  fever  were  cured  by  the 
bark,  clearly  proves  that  fevers  of  the  fame  feafon 
differ  very  much,  according  to  the  nature  of  the 
exhalations  which  excite  them.    The  intermittents  in 
thefe   flrangers    were    excited   by  miafma  of   lefs 
force  than  that  which  was  generated  in  our  city, 
in  which,  from  the  greater  heat  of  the  atmofphere, 
and  the  more  heterogeneous  nature  of  the  putrid 
matters  which  llagnate  in  our  ponds  and  gutters, 
the  exhalation  probably  poiTeffes  a  more  a£live  and 
VOL.  IV.  G  Simulating 


98  AN    ACCOUNT    OF    THE 

{limulatiiig  quality.  Thus  the  mild  remittents  la 
June  and  in  the  beginning  of  July,  which  were 
produced  by  the  ufual  filth  of  the  flreets  of  Phila- 
delphia, in  the  year  1793,  differed  very  much  from 
the  malignant  remitting  yellow  fever  which  was  pro- 
duced by  the  ftench  of  the  putrid  coffee  a  few  weeks 
afterv/ards. 

Sir  John  Pringle  long  ago  taught  the  inefEcacy 
of  bark  in  certain  bilious  fevers.  But  Dr  Chilliolm 
has  done  great  fervice  to  medicine  by  recording  its 
ill  effe£ts  in  the  Boullam  fever.  "  Head  ach,  (fays 
the  Do£lor)  a  heavy  dull  eye,  with  a  confiderable 
protrufion  from  its  orbits,  low  fpirits,  thirff,  and  a 
total  want  of  appetite,  were  the  general  confequen- 
ces  of  the  treatment  with  bark  without  the  previous 
antiphlogiflic." 

I  have  mentioned  a  cafe  of  internal  dropfy  of  the 
brain  having  been  produced  by  the  improper  ufe  of 
the  bark  in  a  fon  of  Mr.  Coates.  I  have  no  doubt 
but  this  diforder,  as  alfo  palfy,  and  confumption, 
obflruftions  of  the  liver  and  bowels,  and  dropfies 
of  the  belly  and  limbs,  are  often  induced  by  the  ufe 
of  the  bark  during  an  inflammatory  flate  of  the 
blood- veffels.  It  is  to  be  lamented  that  the  affoci- 
ation  of  certain  difeafes  and  remedies  in  the  minds 
of  phyficians,  becomes  fo  fixed,  as  to  refufe  to  yield 

to 


BILIOUS    YELLOW    FEVER,    IN    1 794.  OO 

to  the  influence  of  reafon.  Thus  pain  and  orium-, 
dropfy  and  foxglove,  low  fpirits  and  aflafoet  da, 
and  above  all,  an  intermitting  fever  and  bark,  are 
all  conne6J:ed  together  in  common  pra6lice  as  mecha- 
nically, as  the  candle  and  the  fnufFers  are  in  the 
mind  of  an  old  and  fleady  houfe  fervant.  To  abo- 
hili  the  mifchief  of  thefe  mechanical  alTociations  in 
medicine,  it  will  be  necelTary  for  phyficians  to  pre- 
fcribe  only  for  the  different  flates  of  the  fyflem. 

Finding  the  bark  to  be  fo  univerfally  ineffe^ual 
or  hurtful,  I  fubftituted  Columbo  root,  the  Carri- 
bean  bark  and  feveral  other  bitters  in  its  place,  but 
without  fuccefs.  They  did  lefs  harm  than  the 
Jefuit's  bark,  but  they  did  not  check  the  return  of 
a  fmgle  paroxyfm  of  fever. 

I  know  that  bark  was  given  in  this  fever  in  fome 
inllances  in  which  the  patients  recovered ;  but  they 
were  fubje£l  during  the  winter,  and  in  the  following 
fpring,  to  frequent  relapfes,  and  in  fome  inllances  to 
affe^cions  of  the  brain  and  lungs.  In  the  highefl 
grade  of  the  fever  it  certainly  accelerated  a  fuppofed 
putrefaction  of  the  blood,  and  precipitated  death- 
The  praflice  of  phyficians  who  create  this  gangre- 
nous ilate  of  fever  by  means  of  the  bark,  refembles 
the  ccndu<5l  of  a  horfe,  who  attempts  by  pawing  to 

G  2  remove 


lOO  AN    ACCOUNT    OF    THE 

remove  his  fliadow  in  a  ftream  of  water,  and  thereby 
renders  it  (o  turbid  that  he  is  unable  to  drink  it. 

Should  the  immediate  fuccefs  of  tonic,  and  de- 
pleting remedies  in  dedroying  the  fever  be  equal, 
the  effe^ls  of  the  former  upon  the  conflitution  can- 
not fail  of  being  lefs  fafe  than  the  latter  remedies. 
They  cure  by  overflraining  the  powers  of  life.  There 
is  the  fame  difFerence  therefore  between  the  two 
modes  of  pra£tice5  that  there  is  between  gently  lift- 
ing the  latch  of  a  door,  and  breaking  it  open  in 
order  to  go  into  a  houfe. 

Wine  was  hurtful  in  every  cafe  of  yellow  fever 
in  which  it  was  given  while  there  v/ere  any  remains 
of  inflammatory  aftion  in  the  fyflem.  I  recolle£^ 
that  a  few  fpoonsful  of  it,  which  Mr.  Harrifon  of 
Virginia  took  in  the  deprefled  flate  of  his  pulfe, 
excited  a  fenfation  in  his  llomach  which  he  com- 
pared to  a  fire.  Even  wine-whey,  in  the  excitable 
flate  of  the  fyflem  induced  by  this  fever,  was  fome- 
times  hurtful.  In  a  patient  of  Dr.  Phyfick  who 
was  on  the  recovery,  it  produced  a  relapfe  that  had 
nearly  proved  fatal  in  the  year  1795.  Dr.  Defper- 
rieres  afcribcs  the  death  of  a  patient  to  a  fmall 
quantity  of  wine  given  to  him  by  a  black  nurfe.* 

*  Vol.  II.  p.  108. 

Thefc 


BILIOUS    YELLOW    FEVER,    IN    1 794,        lOI 

Thefe  h^ts  are  important,  inafmuch  as  wine  is  a 
medicine  which  patients  are  mofl  ap|:  to  ufe  in  ajl 
cafes,  without  the  advice  of  a  phyfician. 

I  obferved  opium  to  be  lefs  hurtful  in  this  fever 
than  it  was  in  the  fever  of  1793.  I  adminiftered  a 
few  drops  of  laudanum,  in  one  cafe  in  the  form  of  a 
glyfter  in  a  violent  pain  of  the  bowels,  with  evident 
advantage,  before  the  inflammatory  a^lion  of  the 
blood  velTels  was  fubdued.  In  this  way  I  have  often 
obtained  the  compofing  eifefts  of  laudanum  where 
it  has  been  reje£led  by  the  flomach.  But  I  gave  it 
fparingly,  and  in  fmall  dofes  only,  in  the  early  flage 
of  the  fever.  John  Madge,  whofe  pains  in  his 
bowels  were  often  as  exquifite  as  they  are  in  the 
mofl  acute  colic,  did  not  take  a  fmgle  drop  of  it, 
I  ufed  no  anodyne  in  his  cafe  but  bleeding,  and  ap- 
plications of  cold  water  to  the  infide  and  outfide  of 
his  bowels.  After  the  fever  had  palled  the  feventh 
day,  and  had  been  fo  far  fubdued  by  copious  eva- 
cuations as  to  put  on  the  form  of  a  common  inflam- 
matory intermittent,  I  gave  laudanum  during  the 
intermiflipns  of  the  fever  with  great  advantage.  In 
fom,e  cafes,  it  fuddenly  checked  the  paroxyfms  of 
the  fever,  while  in  many  more  it  only  moderated 
them,  but  in  fuch  a  manner,  that  they  wore  them- 
felves  away  in  eight  or  ten  days.  One  of  my  female 
patients  who  had  taken  bitters  of  every  kind,  with- 

G  3  out 


I02  AN    ACCOUNT    OF    THE 

out  effect  to  cure  a  tertian  which  fucceeded  a  yel- 
low fever,  took  a  large  dofe  of  laudanum  in  the  in- 
terval of  her  paroxyfms  to  cure  a  tooth  ach.  To 
her  great  furprife  it  removed  her  tertian.  The 
elfedls  of  laudanum  in  this  fever  were  very  different 
from  thofe  of  bark;  Where  it  did  no  fcrvice,  it  did 
not,  like  the  bark  do  any  harm. 

Perhaps  this  dilFerence  In  the  operation  of  thofe 
two  medicines  depended  upon  the  bark  acling  with 
an  allringent,  as  well  as  ftimulating  power  chiefly 
upon  the  blood  vefTels,  while  the  atlion  of  the 
opium  was  more  fmiply  flimulating,  and  diffufed  at 
the  fame  time  over  all  the  fyilems  of  the  body. 

I  fliall  fay  in  another  place  that  I  fornetimes  direft- 
ed  a  few  drops  of  laudanum  to  be  given  in  that  flate 
of  extreme  debility  which  fucceeds  a  paroxyfm  of 
fever^  v/ith  evident  advantage. 

Nitre,  fo  ufeful  In  common  inflammatory  fevers, 
was  in  moll  cafes  fo  offenfive  to  the  flomach  in  this 
fever,  that  I  was  feldom  able  to  give  it.  Where 
the  flomach  retained  it,  I  did  not  perceive  it  to  do 
any  fervice. 

Antimonials  were  as  inefre£]:ual  as  nitre  In 
abating  the  aflion  of  the  fanguiferous  fyflem,  and  in 

producing 


BILIOUS    YELLOW    FEVER,    IN    1 794.        I03 

producing  a  fweat.  I  fhould  as  foon  expert  to  com- 
pofe  a  ftorm  by  mufic,  as  to  cure  a  yellow  fever 
by  fuch  feeble  remedies. 

Thus  have  I  finiflied  the  hiftory  of  the  fymptoms, 
origin,  and  cure  of  the  yellow  fever  as  it  appeared  in 
Philadelphia  in  1794  and  in  the  winter  of  1795. 
The  eiSicacy  of  the  remedies  which  have  been  men- 
tioned, was  eftabliflied  by  almofl  univerfal  fuccefs. 
Out  of  upwards  of  200  patients  to  whom  I  was  call- 
ed in  the  firll  ftage  of  the  fever  between  the  1 2  th 
of  June  1794  and  the  firft  of  April  i795)  I  loll:  but 
four  perfons  in  whom  the  unequivocal  fymptoms  had. 
occurred,  w^hich  chara^Slerife^  the  firfl  grade  of  the 
difeafe.  • 

It  will  be  ufeful,  I  hope,  to  relate  the  cafes  of  the 
patients  whom  I  loft,  and  to  mention  the  caufes  of 
their  deaths.  The  iirft  of  them  was  Mrs.  Gavin. 
She  objefted  to  a  fifth  bleeding  in  the  beginning  of 
a  paroxyfm  of  her  fever,  and  died  from  the  want 
of  it.  Her  death  was  afcribed  to  the  frequency  of 
her  bleedings  by  the  enemies  of  the  depleting  fyftem. 
It  was  faid  that  flie  had  been  bled  ten  times,  o wing- 
to  ten  marks  of  a  lancet  having  been  difcovered  on 
her  arms  after  death,  five  of  which  were  occafioned 
by  unfuccefsful  attempts  to  bleed  her.  She  died 
with  the  ufual  fymptoms  of  congeftion  in  her  brain. 

G  4  Mr, 


J 04  AN    ACCOUNT    OP    THE 

Mr.  Marrj  to  whom  I  v/as  called  on  the  firft  dav 
of  his  diibrder,  died  in  a  paroxyfm  of  his  fever  which 
came  on  in  the  middle  of  the  7th  nightj  after  fix 
>)leedings.  I  had  left  him  the  night  before  nearly- 
free  of  fever^  and  in  good  fpirits.  He  might  pro- 
Ibably  have  been  faved,  (humanly  fpeaking)  by  one 
more  bleeding  in  the  exacerbation  of  what  appeared 
to  be  the  critical  paroxyfm  of  his  fever* 

Mr.  Montford  of  the  State  of  Georgia  died  under 
the  joint  care  pf  Dr.  Phyfick  and  myfelf.  He  had 
been  cured  by  plentiful  bleeding,  and  purging, 
but  had  reiapfed.  He  appeared  to  expire  in  a  fainty 
fit  in  the  firfl  ftagp  of  a  paroxyfm  pf  the  fever. 
Death  from  this  caufe  (which  occurs  moil:  frequently 
where  bloodletting  is  not  ufed)  is  common  in  the 
yellow  fever  of  the  Weil  Indies.  Dr.  Biffet  in  de- 
fcribing  the  different  ways  in  which  the  difeafe  ter- 
minates fatally  fays.  "  In  a  few  cafes,  the  patient 
is  carried  off  by  an  u?iexpe6led  fyncopeJ^'  * 

A  fervant  of  Mr,  Henry  Mitchell,  to  whom  I 
was  called  in  the  early  ffage  of  his  diforder,  died 
in  confequence  of  a  fudden  effufion  in  his  lungs 
which  had  been  weakened  by  a  previous  pulmonary 
complaint. 

*  Medical  EiTays  and  Obfervations,  p.  28. 

I  wlili 


^  'j. 


BILIOUS    YELLOW    FEVER,    IK    1 794.         IC5 

I  wiih  the  friends  of  bark  and  wine  in  tlie  yel- 
low fever,  or  of  moderate  bleeding  with  antimonial 
medicines,  would  publifii  an  account  of  the  number 
of  their  deaths  by  the  fever,  within  the  period  I 
have  mentioned,  and  with  the  fame  fidelity  I  have 
done.     The  contrafl  w^ould  for  ever  decide  the  con- 
troverfy  in  favour  of  copious  depletion.     The  mor- 
tality under  the  tonic  mode  of  practice  may  eafiiy 
be  conceived  from  the  acknowled element  of  one  of 
the  gentlemen  who  ufed  it,  but  who  premifed  it, 
in  many  cafes^  by  two  and  three  bleedings.     He 
informed  Dr.  Woodhoufe  that  out  of  twenty-feven 
patients  whom  he  had  attended  in  the  yellow  fever, 
he  had  faved  but  nine.     Other  pra£litioners  w^re, 
I  believe,  equally  unfuccefsful  in  proportion  to  the 
number  of  patients  whom    they    attended.     The 
reader  will  not  admit  of  many  deaths  having  occur- 
red  uoxa   the  difeafes    (formerly  enumerated)    X.o 
which  they  were  afcribed,  when  he  recoilefts  that 
even  a  fmgle  death  from  moil  of  them,  in  common 
feafons,  is  a  rare  occurrence  in  the  practice  of  re- 
gular bred  phyficians. 


In  anfwer  to  the  account  I  have  given  of  the  mor- 
tality of  the  fever  in  1794,  it  will  be  faid,  that  30 
perfons  died  lefs  In  that  year,  than  in  the  healthy 
year  of  1792.  To  account  for  this,  it  will  be  ne- 
f  elTary  to  recollecl:  that  the  inhabitants  of  Philadel- 
phia 


Io6  AN    ACCOUNT    OF    THE 

phia  were  reduced  in  number  upwards  of  4000, 
in  the  year  1793  and  of  courfe  that  the  proportion 
of  deaths  was  greater  in  1794  than  it  was  in  1792 
although  the  number  was  lefs.  It  is  remarkable 
that  the  burials  in  the  Grangers'  grave  yard  amount- 
ed in  the  year  1792  to  but  201,  whereas  in  1794 
they  were  676.  From  this  it  appears,  that  the  deaths 
muil  have  been  very  numerous  among  new  comers 
(as  they  are  fometimes  called)  in  the  year  1794 
com-pared  with  common  years.  Now  this  will  eafily 
be  accounted  for  when  we  recolle£l5  that  thefe 
people  who  were  chiefly  labourers,  were  expofed  to 
the  conllantly  exciting  caufes  of  the  difeafe,  and 
that  in  all  countries  they  are  the  principal  fuiFerers 
by  it. 

But  in  order  to  do  juflice  to  this  comparative 
view  of  the  mortality  induced  by  the  yellow  fever 
in  the  year  1 794,  it  will  be  neceffary  to  examine  the 
bill  of  mortality  of  the  fucceeding  year.  By  this  it 
appears  that  2274  perfons  died  in  1795,  making 
1139  more  than  died  in  1.794.  The  greatnefs 
of  this  mortality,  I  well  recolleft,  furprized  many  of 
the  citizens  of  Philadelphia  who  had  juft  pafTed  an 
autumn  which  was  not  unufually  fickly,  and  who 
had  forgotten  the  uncommon  mortality  of  the  months 
of  January,  February  and  March,  which  fucceeded 
the  autumn  of  1 794. 

It 


BILIOUS    YELLOW    FEVER,    IN     1 794.         I07 

It  will  probiibly  be  afked,  how  it  came  to  pafs, 
that  I  attended  (o  many  more  patients  in  this  fever 
than  any  of  my  brethren.  To  this  I  anfwer,  that 
fmce  the  year  1793  a  great  proportion  of  my  patients 
have  confiftcd  of  Grangers,  and  of  the  poor  ;  and 
as  they  are  more  expofed  to  the  difeafe  than  other 
people,  it  follows,  that  of  the  perfona  affected  by 
the  fever,  a  greater  proportion  mufl:  have  fiillen  to 
my  (liare  as  patients,  than  to  other  phyficians.  My 
ability  to  attend  a  greater  number  of  patients  than 
moil  of  my  brethren,  was  facilitated  by  my  having 
at  the  time  of  the  fever,  feveral  ingenious  and  aflive 
pupils,  who  aiTiiled  me  in  vifiting  and  prefcribing 
for  the  fick.  Thefe  pupils  were,  Ailiton  Alexander 
(now  phyfician  at  Baltimore),  John  Otto,  Nathaniel 
Potter  (nov/  phyficians  in  Philadelphiaj,  and  Gilbert 
Watfon. 

The  antiphiogillic  remedies  were  not  faccefsful  in 
Philadelphia,  in  the  yellow  fever,  in  my  hands 
alone.  They  were  equally,  and  perhaps  more  fo, 
in  the  hands  of  my  friends  Dr.  Gritlitts,  Dr.  Ph}^- 
fick.  Dr.  Dewees,  and  Dr.  Woodhoufe. 

They  were  moreover  fuccefsful  at  the  fame  time 
in  New  Haven,  Baltimore,  and  in  Charlefton  in 
South  Carolina.  Eighteen  out  of  twenty  died  of 
all  who  took  bark  and  wine  in  New  Haven,  but 

only 


I08  AN    ACCOUNT    OF    THE 

only  one  in  ten,  of  thofe  who  ufed  the  depleting 
medicines.  In  a  letter  from  Dr.  Brown,  a  phy- 
fician  of  eminence  in  Baltimore,  dated  November 
27th,  17945  he  fays,  "  of  the  many  cafes  which  fell 
to  my  care,  two  only  proved  mortal  where  I  was 
called  on  the  firfl  day  of  the  difeafe,  and  had  an  un- 
controuled  opportunity  to  follow  my  judgment. 
Where  falivation  took  place,  I  had  no  cafe  of  mor- 
tality ;  and  in  two  of  thofe  cafes  a  black  vomiting 
occurred."  Dr.  Ramfay  of  Charleilon,  in  a  letter 
to  one  of  his  friends  in  this  city,  dated  061:ober 
14th,  1794,  fubfcribes  to  the  efEcacy  of  the  fam.e 
pra&ce  in  a  fever  which  prevailed  at  that  time  in 
Charleflon,  and  which,  he  fays,  refembled  the  yeli 
low  fever  of  Philadelphia  in  the  year  1793. 

But  the  fuccefs  of  the  depleting  fyftem  was  not 
confined  to  the  United  States.  In  a  letter  before 
quoted,  which  I  received  from  Dr.  Davidfon  of  St. 
Vincents,  dated  July  22d,  1794,  there  is  the  fol- 
lowing  teflimony  in  favour  of  evacuations  from  the 
blood-veiTels,  bowels,  and  falivary  glands. 

"  Where  the  fever  comes  on  with  great  deter- 
mination to  the  head,  and  an  afFe£lion  of  the  fto- 
mach,  in  confequence  of  that  determination,  vio- 
lent  head  ach,  rednefs  of  the  eyes,  turgefcence  of 
the  face,  impatience  of  light,    &c.    attended  with 

a  full 


BILIOUS    YELLOW    FEVER,    IN    1794.        I09 

a  full  and  hard  pulfe,  blood-Iettmg  ihould  be  em- 
ployedyr^Wj  and  repeatedly^  cold  applications  ihould 
be  applied  to  the  head,  and  purging  medicines 
ihould  be  employed.  As  a  purge,  calomel  has  been 
ufed  with  the  greatefl  advantage,  fometimes  by  it- 
felf,  but  moil  frequently  combined  with  fome  aftive 
purgative  medicine,  fuch  as  jalap.  From  fome 
peculiarity  in  the  difeafe,  an  uncommon  quantity 
of  the  calomel  is  neceiTary  to  aifeiSi:  the  bowels  and 
falivary  glands.  As  I  found  a  fmall  quantity  of 
it  did  not  produce  the  efFe£l  I  wiihed  for  promptly, 
I  have  gradually  increafed  the  quantity,  until  I 
now  venture  to  give  ten  grains  of  it,  combined 
with  five  of  jalap,  every  two  hours  until  flools  are 
procured.     The  calomel  is  then  given  by  itfelf. 

"  The  patients  have  generally  an  averiion  to 
wine.  The  bark  is  feldom  found  of  much  advan- 
tage in  this  ilate  of  the  fever,  and  frequently 
brought  on  a  return  of  the  vomiting.  I  preferred 
to  it,  in  a  remiiTion  of  the  fymptoms,  a  vinous 
infufion  of  the  quaiTia,  which  fat  better  upon  the 
ftomach." 

In  the  ifland  of  Jamaica,  the  depleting  fyftem 
has  been  divided.  It  appears  from  feveral  publica- 
tions in  the  Kingfton  papers,  that  Dr.  Grant  had 
ad(^ted  blood-letting,  while  moil  of  the  phyficians 

of 


no  AN    ACCOUNT    OF    THJi 

of  the  ifland  reft  the  cure  of  the  yellow  fever 
upon  ftrong  mercurial  purges.  The  ill  effects  of 
moderate  bleeding  appear  to  have  thrown  the  lan- 
cet into  difrepute  ;  and  the  balance  of  fuccefs,  from 
thofe  publications,  is  evidently  in  favour  of  fimple 
purging.  I  have  no  doubt  of  the  truth  of  the 
above  ftatement  of  the  controverfy  between  the 
exclufive  advocates  for  bleeding  and  purging  ;  and 
I  think  the  fuperior  efficacy  of  the  latter  remedy 
may  be  explained  in  the  following  manner. 

In  warm  climates  the  yellow  fever  is  generally, 
as  it  v/as  in  Philadelphia  in  the  month  of  Auguil 
and  in  the  beginning  of  September  1793,  a  dif- 
eafe  of  but  tv^o  or  three  paroxyims.  It  is  fome- 
times,  I  believe,  only  a  fimple  ephemera.  In  thefe 
cafes,  purging  alone  is  fufficient  to  reduce  the  fyf- 
tem,  without  the  a.id  of  bleeding.  It  was  found 
to  be  fo,  until  the  beginning  of  September  in  1793, 
in  moft  cafes  in  Philadelphia.  The  extreme  de- 
prellion  of  the  fyftem  in  the  yellow  fever  in  warm 
weather  and  in  hot  climates,  renders  the  reftora- 
tion  of  it  to  a  healthy  ftate  of  a6lion  more  gradual, 
and  of  courfe  more  fafe,  by  means  of  purging,  than 
bleeding.  The  latter  remedy  does  harm,  only  by 
reftoring  the  blood-veflels  too  fuddenly  to  preterna» 
tural  aftion,  without  reducing  them  afterwards. 
Had  bleeding  been  pra6tifed  agreeably  to  the  me- 
thod 


BILIOUS    YELLOW    FEVER,    IN    1 794.         Ill 

thod  defcribed  by  RIverius,  (mentioned  in  a  former 
publication  *),  or  had  the  fever  in  Jamaica  run  on 
to  more  than  four  or  five  paroxyfms,  I  am  fure  the 
lofs  of  blood  would  have  been  not  only  fafe,  but 
generally  beneficial.  I  have,  in  another  place,  f 
given  my  reafons  why  moderate  bleeding  in  this,  as 
well  as  many  other  difeafes,  does  harm.  In  thofe 
cafes  where  it  has  occurred  in  large  quantities  from 
natural  haemorrhages,  it  has  always  done  fervice  in 
the  Weft  Indies.  The  inefficacy,  and  in  fome  cafes, 
the  evils,  of  moderate  blood-letting  are  not  confined 
to  the  yellow  fever.  It  is  equally  inefieflual,  and 
in  fome  inftances  equally  hurtful,  in  apoplexy,  in- 
ternal dropfy  of  the  brain,  pleurify,  and  pulmonary 
confumption.  Where  all  the  different  ftates  of  the 
pulfe  which  indicate  the  lofs  of  blood  are  perfe£lly. 
underftood,  and  blood-letting  conformed  in  time  and 
in  quantity  to  them,  it  never  can  do  harm  in  any 
difeafe.  It  is  only  when  it  is  prefcribed  empirically, 
without  the  dire^ion  of  juft  principles,  that  it  has 
ever  proved  hurtful.  Thus  the  fertilizing  vapors 
of  heaven,  when  they  fall  only  in  dew,  or  in  profufe 
lliowers  of  rain,  are  either  infufficient  to  promote 
vegetation,  or  altogether  defti*u£live  to  it. 

There  may  be  habits  in  which  great  and  long 
protraifbed  debility,  whether  direcl  or  indiredi:,  may 

*  Account  of  the  Yellow  Fever  in  1793.         t  Il^itiem. 

have 


112  AN    ACCOUNT    OF    tHE 

have  fo  far  exliaufled  the  aci:ive  powers  of  the  fyf- 
tem,  as  to  render  bleeding  altogether  improper  in 
this  difeafe,  in  a  Weft  India  climate.     Such  habits 
are  fometimes  produced  in  foldiers  and  failors  by 
the  hardiliips  of  a  military  and  naval  life.     Bleeds 
ing  in  fuch  cafes.  Dr.  Davidfon  alTures  me  in  a  let- 
ter dated  from  Martinique,  February  29th ,    1796, 
did  no  good.     The  cure  was  effedled  under  thefe 
circumflances  by  purges,  and  large  dofes  of  calomel. 
But  where  this  chronic   debility  does  not  occur, 
bleeding,  when  properly  ufed,  can  never  be  inju- 
rious, even  in  a  tropical  climate,  in  the  yellow  feven 
Of  this  there  are  many  proofs  in  the  writings  of 
the  mod:  refpe£l:able  Englifli  and  French  phyficians. 
In  fpite  of  the  fears  and  clamors  v/hich  have  been 
lately  excited  againil  it  in  Jamaica,  my  late  friend 
and  cotemporary  at  the  college  of  Edinburgh,  Dr. 
Broadbelt,  in  a  letter  from  Spanifli  Town,  dated 
January  6th,  1795,  and  my  former  pupil  Dr.  Wef- 
ton,  in  a  letter  from  St.  Ann's  Bay,  dated  June 
17th,  1795,  both  affure  me  that  they  have  ufed  it 
in  this  fever  with  great  fuccefs.     Dr.  Wefton  fays 
that  he  bled  "  copioujiy  three  times  in  24  hours,  and 
thereby  faved  his  patient.'* 

Dr.  Chilliolm  has  lately  endeavoured  to  reft  the 
cure  of  malignant  fevers  wholly  upon  the  evacua- 
tion obtained  from  the  falivary  glands,  by  means  of 

I  mercury. 


fitLlOUS    YELLOW    FEVER,    IN     1794.         II3 

tntrcuiy.  I  have  no  doubt  of  the  efficacy  of  the 
Doctor's  praiflice,  but  from  his  own  account  it  was 
much  lefs  fuccefsful  than  the  practice  in  the  United 
States  has  been,  from  the  combined  operation  of 
bleeding,  purging,  and  a  faHvation.  From  the  de- 
fcription  which  the  Doiflor  has  given  of  the  (late 
of  the  pulfe,  of  the  frequent  haemorrhages  which 
occurred  in  the  Boullam  fever,  and  of  the  ftate  of 
the  brain  after  death,  I  am  fatisfied  that  bleeding 
and  purging  would  have  rendered  his  pra6i:ice  much 
more  fuccefsful.  Notwithflanding  the  Boullam  fever 
was  highly  inflammatory,  it  was  materially  different 
from  the  yellow  fever  of  the  Wefl  Indies  and  of 
the  American  States.  This  appears  i.  From  its 
origin,  it  having  been  produced  by  human  miaf- 
mata  in  an  African  veffel  which  arrived  at  Gre- 
nada, and  not  by  marfh  exhalation.  2.  From  its 
being  contagious  in  the  Well  Indies,  which  Dr. 
Chifliolm  fays  is  never  the  cafe  with  the  yellow 
fever  *.  3.  From  its  infedling  at  the  dillance  of  but 
6,  8,  or  10  feet;  whereas  the  yellow  fever  infers 
at  the  dillance  of  20  and  30  feet.  4.  From  the 
yellow  fever,  and  a  fever  compofed  of  the  com- 
bined contagions  of  the  Boullam  a.nd  yellow  fevers, 
prevailing  at  the  fame  time  in  Grenada. 

;  ^  P.  147, 

II  I  fay 


114  -AN    ACCOUNT    OF    THE 

I  fay  nothing  of  the  difference  of  the  fymptoms 
in  the  two  fevers,  for  this  depends  upon  circum- 
flances  purely  accidental.  In  both,  the  contagion 
a£ls  like  other  violent  and  general  flimuli,  which  all 
produce  nearly  the  fame  effects  upon  the  fyflem. 

From  Dr.  Chifliolm  being  unacquainted  at  the 
time  he  compofed  his  book,  with  the  hiflory  of  the 
yellow  fever  of  Philadelphia  in  the  year  1793,  he 
has  afferted  that  it  was  the  fame  difeafe  that  pre- 
vailed at  Grenada,  and  ^hat  it  had  been  conveyed 
from  that  ifland  to  Philadelphia.  The  affertion  fur- 
liiflied  a  fliort  lived  triumph  to  fome  of  the  phyfi- 
cians  of  Philadelphia  ;  but  the  facls  which  I  have 
mentioned  from  the  Dolor's  book,  foon  fliev/ed  it 
to  be  without  the  lead  foundation. 

The  fuperior  advantages  of  the  North  American 
mode  of  treating  the  yellow  fever  by  means  of  all 
the  common  antiphlogiflic  remxedies,  will  appear 
from  comparing  its  fuccefs,  with  that  of  the  Wefl 
India  phyficians,  under  all  the  modes  of  practice 
w^hich  have  been  adopted  in  the  iflands.  Dr.  Def- 
portes  lofl  one  half  of  all  the  patients  he  attended 
in  the  yellow  fever  in  one  feafon  in  St.  Domingo.  * 
His  remedies  vv^ere  moderate  bleeding,  and  purging, 
and  the  copious  ufe  of  diluting  drinks.     Dr  Biffet 

*  Vol.  I.  p.  $^. 
I  fays, 


BILIOUS    YELLOW    FEVER,    IN     1794.         II5 

fays,  "  the  yellow  fever  is  often  under  particular 
circumflances  very  fiital,  carrying  off  four  or  five  in 
feven  whom  it  attacks,  and  fometimes,  but  feldom, 
it  is  fo  favourable,  as  to  carry  off  only  one  patient 
in  five  or  fix."  *  The  Doctor  does  not  defcribe  the 
practice  under  which  this  mortality  takes  place. 

Dr.  Home,  I  have  elfewhere  remarked,!  lofi:  "one 
out  of  four  of  his  patients  in  Jamaica.  His  remedies 
were  moderate  bleeding,  and  purging,  and  after- 
wards bark,  wine,  and  external  applications  of  blan- 
kets dipped  in  hot  vinegar. 

Dr.  Blane  pronounces  the  yellow  fever  to  be  ^^  one 
of  the  mofi:  fatal  difeafes  to  which  the  human  body 
is  fubjecl,  and  in  v/hich  human  art  is  the  moil  unavail- 
ing." His  remedies  were  bleedingj  bark,  bliflers, 
acid  drinks,  faline  draughts,  and  camomile  tea. 

Dr.  Chifliolm  acknowledges  that  he  lofi:  one  in 
twelve  of  all  the  patients  he  attended  in  the  jail 
fever.  His  principal  remedy  was  a  falivation.  I 
iliall  hereafter  fliew  the  inferiority  of  this  fingle 
mode  of  depleting,  to  a  combination  of  it  with  bleed- 
ing and  purging.  In  Philadelphia,  and  Baltimore 
where  bleeding,  purging,  and  falivation  were  ufed 

*  Medical  E flays  and  Obfervations,  p.  29, 
f  Account  of  die  yellow  fever  in  1793. 

n  2  in 


Il6  AN    ACCOUNT    OF    THE 

In  due  time,  and  after  the  manner  that  has  been 
defcribcd,  not  more  than  one  in  fifty  died  of  the  yel- 
low fever.     It  is  probable  that  greater  certainty  and 
fuccefs  in  the  treatment  of  this  difeafe,  will  not  eafily 
be  attained,  for  idiofyncracy,  and  habits  of  intem- 
perance which  refill  or  divert  the  operation  of  the 
mofh  proper  remedies,  a  dread  of  the  lancet,  or  the 
delay  of  an  hour  in  the  ufe  of  it,  the  partial  appli- 
cation of  that  or  any  other  remedy,  the  unexpe^led 
recurrence  of  a  paroxyfm  of  fever  in  the  middle  of 
the  night,  or  the  clandeftine  exhibition  of  wine  or 
laudanum  by  friends,  or  neighbours,  often  defeat  the 
befh  concerted  plans  of  cure  by  a  phyfician.    Heaven 
in  this,  as  in  other  inftances,  kindly  limits  human 
power,  and  benevolence,  that  in  all  fituations  man 
may  remember  his  dependence  upon  the  power  and 
goodnefs  of  his  Creator.* 

*  An  innate  dread  of  the  lancet,  deprived  the  world  pre- 
maturely, of  the  talents  and  virtues  of  William  Bradford 
Efq.  Attorney  General  of  the  United  States,  on  the  23d  of 
Augufl;  1795.  ^^  refufed  to  fubmit  to  bleeding  in  a  malig- 
nant bilious  fever  for  five  days,  during  which  time  fuch  ef- 
fufions  took  place,  as  rendered  that,  and  other  remedies  in- 
effedual  in  his  cafe.  I  ftiall  long,  very  long,  mourn  the 
death  of  this  excellent  man.  He  was  to  me  a  friend  and  a 
brother.  The  delay  of  bleeding  for  one  night  only,  during 
a  fevere  paroxyfm  of  the  fame  (late  of  fever,  deprived  me  cf 
a  beloved  pupil  Mr.  Gilbert  Watfon  on  the  25th  of  Septem- 
ber of  the  fame  year.     He  caught  it  by  the  moft  extraordinary 

exertions 


BILIOUS    YELLOW    FEVER,    IN    1 794.         llj 

This  victory  Incomplete  as  it  is,  over  a  difeafe, 
once  the  terror  and  fcourge  of  mankind,  has  not 
been  a  cheap  one.  It  has  been  purchafed  at  the 
expenfe  of  much  hibour  and  obloquy.  The  num- 
ber of  the  perfons  who  have  died  under  my  care, 
has  been  much  exaggerated,  and  the  mofl  affefting 
llories  have  been  circulated  of  their  dying  under  the 
immediate  ufe  of  my  remedies.  A  fmgle  death 
where  bleeding  had  been  ufed  without  fuccefs,  has 
injured  my  reputation  more  than  twenty  deaths 
created  by  the  negle^l  of  it,  or  by  the  improper 
ufe  of  tonic  remedies,  have  injured  other  phy- 
ficians.  Nay,  further,  the  palenefs  which  is  induced 
by  bleeding,  has  in  a  fmgle  inflance,  been  urged 
with  more  fuccefs  to  difcredit  my  pra61:ice,  than  a 
dozen  deaths  would  have  been,  had  I  confined  myfelf 
to  the  ufual  remedies  for  fever.  The  reader  will 
conceive  of  the  horror  with  which  my  prafiice  of 
bleeding  in  this  fever  is  viewed,  when  I  add,  that 
a  lady  who  vifited  one  of  my  female  patients  whom 
I  had  bled  feveral  times,  implored  her  upon  her  knees 
not  to  permit  me  to  bleed  her  any  more.  Her 
prayer  had  no  eftcifr.  I  bled  her  frequently  after- 
wards, but  that  ilie  might  not  be  diflurbed  by  a 
repetition  of  the  entreaties  of  her  friend,  I  concealed 

exertions  of  fk'll  and  humanity  in  attending  and  nurfing  \ 
Tick  family,  on  the  Delaware,  about  20  nules  from  Phila- 
delphia. 

H  3  the 


Il8  AN    ACCOUNT    ScC, 

the  blood,  at  her  requeft,  each  thne  after  drawhig  it 
in  a  clofet,  nor  was  it  known  that  I  did  fo,  until 
fome  time  after  her  recovery. 

I  commit  the  calumnies  which  have  followed  my 
opinions  and  praci:ice  in  this  fever,  to  the  dufl.  If 
the  foil,  I  have  endeavoured  to  cultivate,  fliould 
afford  a  plentiful  harvefl  to  my  pupils,  I  fliall  not 
repine,  although  I  have  reaped  nothing  from  it,  but 
briars  and  thorns.  And  if  my  labours  upon  this 
fubjecl  fliould  be  bleffed  to  the  conviction  and  benefit 
of  the  citizens  of  Philadelphia,  I  fliall  rejoice  in  my 
pcrfecutions. 

To  that  Being  who  often  makes  ufe  of  weak  and 
unworthy  inftruments  to  accomplifli  the  purpofes 
of  his  benevolence,  in  order  thereby  to  fix  the  gra- 
titude of  his  creatures  upon  his  own  almighty  power 
and  goodnefs,  I  defire  thus  publicly  to  record  my 
acknowledgments  for  having  made  me  in  the  fmallefl 
degree  ufeful  to  my  fellow  m.en  in  any  part  of  the 
world,  by  the  revival  and  application  of  remedies 
which  have  fubdued,  in  a  great  meafure,  the  force  of 
a  once  formidable  and  mortal  diforder.  To  his  great 
and  holy  name  be  afcribed  honor,  and  power,  and 
glory,  by  all  his  intelligent  creatures,  for  ever,  and 
ever. 


AN 


INQUIRY 


INTO   THE 


PROXIMATE    CAUSE 


OF 


FEVER. 


AN 


INQJJIRY,  &c. 


m  A  V I N  G  yielded  to  the  follcitations  of 
my  pupils  to  piiblifli  a  defence  of  blood-letting  in 
certain  difeafes,  I  found  that  I  could  not  do  juflice 
to  the  fubjeft,  as  it  relates  to  the  cure  of  fevers, 
without  firfl  delivering  a  few  obfervations  upon  that 
ftate  of  the  blood-veiTels,  which  conftitutes  the 
proximate  caufe  of  fever.  I  fliall  therefore  proceed 
briefly  to  deliver  the  fubflance  of  what  I  have  taught 
for  feveral  years  upon  this  fubje^t  in  the  Univerfity 
of  Pennfylvania,  and  what  has,  for  many  years,  re- 
gulated my  pradice  in  the  treatment  of  fevers. 

Previouily  to  my  entering  upon  this  fubjeci:,  I 
Ihall  give  a  fliort  account  of  the  changes  which  I 
have  made  in  my  opinions  upon  It.  My  firil  prin- 
ciples in  medicine  were  derived  from  Dr.  Boer- 
Jiaave,  and  from  his  aphorifms  as  explained  by 
y.anf\yiete^.i5    I   adopted    my  firfl   ideas   of  fever. 

The 


122  ON    THE    PROXIMATE 

The  reader  may  eafily  conceive  of  the  pains  I  took 
to  become  mailer  of  this  fubje£^,  when  I  add,  that 
before  I  was  twenty  years  of  age,  I  abridged  all 
thofe  vohmies  of  Vanfwieten's  Commentaries  on 
Dr.  Boerhaave's  aphorifms  which  treat  of  fever. 
I  need  hardly  add,  that  Dr.  Boerhaave  placed  its 
proximate  caufe  wholly  in  a  lentor  of  the  blood, 
and  in  morbific  matter. 

When  I  w^ent  to  Edinburgh  in  the  year  1766,  1 
relinquiilied  this  theory  of  fever,  and  embraced  a 
m.ore  rational  one,  firfl  propofed  by  Dr.  Hoffman, 
and  afterwards  revived  with  many  advantages  by 
Dr.  Cullen,  I  mean  the  theory  of  a  fpafm  upon  the 
extremities  of  the  capillary  veiTels  in  every  part  of 
the  furface  of  the  body.  Soon  after  my  fettlement 
in  Philadelphia  in  the  year  1769  I  found  that  this 
theory  did  not  accord  with  many  of  the  phenomena 
of  fever.  I  was  therefore  forced  to  defert  it ;  and 
for  many  years  I  fioundered  upon  an  ocean  of 
doubt  and  uncertainty  with  refpe<5l  to  the  proximate 
caufe  of  fever.  Many  painful  hours  have  I  fpent 
in  contemplating  this  fubjefi:.  At  length  light  broke 
in  upon  my  mind.  The  phenomena  of  fever  fuddenly 
appeared  to  me  in  a  new  order.  I  inflantly  combined 
them  into  a  new  theory.  Whether  this  theory  be 
juft,  or  not,  time  muft  difcover.  Since  I  have 
adopted  it,  my  practice  in  fevers  has  been  more  Am- 
ple, 


CAUSE    OF    FEVER.  1 23 

pIc,  and  far  more  fuccefsful  than  formerly.  It  has 
moreover  thrown  a  light  upon  the  proximate  caufc 
of  feveral  other  difeafes,  and  led  to  a  practice  equally 
fimple  and  fuccefsful  in  them..  I  feel  no  fliaine  in 
thus  publicly  acknowledging  that  I  have  more  than 
once  changed  my  opinions  in  medicine.  To  be  un- 
changeable, belongs  only  to  that  being  who  fees 
things  in  their  order  and  relation  to  each  other  by 
a  fnigle  act  of  intuition.  A  change  in  opinions  is 
the  necelTary  eifeft  of  fuccefTion  in  the  acquifition  of 
knowledge,  and  I  believe  a  new  truth  is  feldom  ac- 
quired by  men  of  common  education,  but  at  the  ex- 
pence  of  an  old  error. 

I  fliall  not  attempt  to  give  a  definition  of  fever. 
It  appears  in  fo  many  different  form?,  that  a  jufl 
view  of  it  can  only  be  given  in  a  minute  detail  of  all 
its  fymptoms  and  dates. 

In  order  to  render  the  theory  of  fever,  which  I 
am  about  to  deliver,  more  fimple  and  intelligible, 
it  will  be  neceflary  to  premife  a  few  general  pro- 
pofitions. 

I.  Fevers  of  all  kinds  are  preceded  by  general 
-debility.  This  debility  is  of  two  kinds,  viz.  direfl: 
and  indire^l:.  The  former  depends  upon  an  ab- 
Itraclion  of  ufual  and   natural  fi:imuh ;   the  latter 

upon 


124  t)N    THE    PROXIMATE 

upon  an  increafe  of  natural,  or  upon  the  a£tion  of 
preternatural  flimuli  upon  the  body.  However  op- 
pofite  thefe  caufes  of  debility  may  be,  they  unite 
in  their  efFedls,  and  that  in  fuch  a  manner,  that  dire(51: 
and  indirect  debility  are  frequently  to  be  diftinguilli- 
ed,  only  by  a  knowledge  of  the  caufes  which  in- 
duce them. 

That  fevers  are  preceded  by  general  debility,  I 
infer  from  their  caufes.  Thefe  aft  direftly  or  in- 
direftly  on  the  fyflem.  I  fliall  firfl  mention  thofe 
caufes  of  fever  which  aft  by  inducing  dired^  and 
afterwards  thofe  which  aft  by  inducing  indired  de- 
bility. 

The  former  are, 

I .  Cold.  This  is  univerfally  acknowledged  to  be 
a  predifpofmg  caufe  of  fever.  That  it  debilitates,  I 
infer,  i.  From  the  languor  which  is  obferved  in  the 
inhabitants  of  cold  countries ;  and  from  the  weaknefs 
which  is  felt  in  labour  or  exercife  in  cold  weather. 
2.  From  the  effefts  of  experiments,  which  prove, 
that  cold  air  and  cold  water  leiTen  the  force  and 
frequency  of  the  pulfe. 

The  other  caufes  of  direft  debility  which  predif- 
pofe  to  fever  are, 

2.  The 


CAUSE    OF    FEVER.  I25 

1.  The  debilitating  paffions  of  fear,  grief,  and 
defpair. 

3.  All  excelTive  evacuations,  whether  by  the 
bowels,  blood-veffels,  pores,  or  urinary  palTages. 

4.  Famine,  or  the  abflraflion  of  the  ufual  quan- 
tity of  nourifhing  food. 

The  caufes  which  predifpofe  to  fever  by  inducing 
indired  debility  are, 

1 .  Heat.  Hence  the  greater  frequency  of  fevers 
in  warm  climates  and  in  warm  weather. 

2.  Intemperance  in  eating  and  drinking, 

3.  Fatigue. 

4.  Certain  caufes  which  a61:  by  over-fb-etching  a 
part  or  the  whole  of  the  body,  fuch  as  lifting  heavy 
weights,  external  violence  acting  mechanically  in 
wounding,  bruifmg,  or  compreflmg  particular  parts, 
extraneous  fubftances  afting  by  their  bulk  or  gra- 
vity, burning,  and  the  like.  *  Some  of  thefe  caufes 
a6l  locally,  but  they  aife^l  the  fyflem  fecondarily  by 


*  Cullen's  Firll  lines. 


inducing 


126  ON    THE    PROXIMATE 

inducing"  in  it  indirect  debility.  I  infer  further,  that 
fevers  depend  upon  predifpofmg  debihty  from  the 
time  in  vi^hich  they  moft  commonly  attack,  viz.  in 
the  night,  when  the  fyflem  is  in  a  ftate  of  debility  ; 
and  from  the  fyraptoms  which  accompany  the  at- 
tack of  a  fever,  fuch  as  weaknefs  in  the  limbs,  in- 
ability to  ftand  or  walk,  coldnefs  or  chills,  fleepinefs, 
a  fiirinki.ng  of  the  hands  and  face,  and  a  weak  or 
quick  puh'e. 


In  anf  iver  to  this  general  propofition  it  may  be 
faid,  that  contagions,  whether  of  the  fmall-pox  or 
meailes,  a<51  without  the  predifpofition  of  debility  ; 
and  that  this  predifpofition  is  not  neceffary  to  pro- 
duce a  fever  from  the  contagions  of  the  plague  or 
yellow  fever.  To  this  I  reply,  that  none  of  thofe 
contagioQs  a«5t  fo  as  to  produce  fever,  until  they 
have  firli^.  induced  indirect  debility  ;  and  that  their 
action  is  more  fpeecly,  certain,  and  violent  in  pro- 
portion to  the  degrees  of  direct  or  indirect  debility 
which  hare  preceded  them.  This  is  fo  well  known, 
that  the  f  afety  or  fatal  iffue  of  fevers  from  conta- 
gion is  generally  expefted,  from  their  having  been 
preceded  by  more  or  lefs  of  the  enumerated  caufes 
of  direct  oj:  indirect  debility. 

II.  Deb.^Oity  is  always  fucceeded  by  increafed  ex- 
citability,   or  a  greater  aptitude  to  be  acted  upon 

by 


CAUSE    OF    FEVER.  1 27 

by  flimuli.  This  Increafe  of  excitability  is  faid  by 
Dr.  Brown  to  be  confined  only  to  a  ftate  of  direci 
debility,  but  it  takes  place  in  all  cafes  of  indire£l: 
debility  ;  where  it  isfuddoih  induced  upon  the  fyf- 
tern.  IndirecH:  and  dire<Si:  debility  are  upon  a  foot- 
ing, where  they  are  of  a  chronic  nature.  They 
both  equally  expend  the  excitability  of  the  fyfteiii, 
and  leave  it  in  a  flate  in  which  llimuli  generally 
adt  with  too  little  force  upon  it  to  excite  in  it  tlie 
commotions  of  fever. 

III.  The  diminution  or  abflra61;ion  of  one  fLimulus 
IS  always  followed  by  the  increafed  a6lion  of  others. 

Let  us  apply  thefe  principles,  before  w^e  lofe  fight 
of  them,  to  the  produ6lion  of  fever. 

Has  the  body  been  debilitated  by  long  expofure 
to  the  cold  air  ? — its  excitability  is  thereby  in- 
creafed, and  heat  acts  upon  it  with  an  accumulated 
force ;  hence  the  frequency  of  catarrhs,  pleurifies, 
and  other  inflammatory  fevers  in  the  fpring,  after 
a  cold  winter ;  and  of  bilious  remittents  in  the  au- 
tumn, when  Vv^arm  days  fucceed  to  cold  and  damp 
nights.  Thefe  difeafes  are  feldom  felt  for  the  firfh 
time  in  the  open  air,  but  generally  after  the  body 
has  been  expofed  to  cold,  and  afterwards  to  the  heat 
of  a  warm  room  or  a  warm.  bed.     Mild  intermit- 

tents 


128  ON    THE    PROXIMATE 

tents  have  frequently  been  obferved  to  acquire  ztt 
inflammatory  type  in  the  Pennfylvania  hofpital,  \u 
the  months  of  November  and  December,  from  the 
heat  of  the  flove  rooms  acling  upon  bodies  prevr- 
oufly  debilitated  by  cold  and  difeafe. 

Has  there  been  an  abflra^lion  of  heat  by  a  fud- 
den  fliifting  of  the  wind  from  the  fouth-wefl  to  the 
north-weil  or  north-eaft  points  of  the  compafs,  or 
by  a  cold  night  fucceeding  to  a  warm  day  ? — a  fever 
is  thereby  frequently  excited.  Thefe  fources  of  fever 
occur  every  autumn  in  Philadelphia.  The  rniaf- 
mata  or  contagion  which  exifl  in  the  body  at  that 
time  in  a  harmlefs  ftate,  are  excited  into  a61ion  by 
the  debility  from  cold,  aided  in  the  latter  cafe  by 
the  inaction  of  fleep  fuddenly  induced  upon  the  fyflem. 

Again :  Has  the  body  been  fuddenly  debilitated 
by  fatigue  ? — its  excitement  is  thereby  diminiflied, 
but  its  excitability  is  increafed  in  fuch  a  manner  that 
the  ftimulus  of  a  full  meal,  or  an  intemperate  glafs 
of  wine,  if  taken  immediately  after  the  fatigue  is 
induced  upon  the  body,  excites  a  fever  ;  hence  the 
frequency  of  fevers  in  perfons  upon  their  return 
from  hunting,  furveying,  long  rides,  or  from  a  camp 
life.  A  fever  from  the  laft  caufe,  was  very  com- 
mon during  the  late  war  in  America.  A  hot  fup- 
per,  and  afterwards  the  heat  of  a  warm  bed,  fome- 

times 


CAUSE    OF    FEVER,  12^ 

times  induced  not  only  fever,  but  a  convulfion  in 
the  nervous  fyftem  in  many  perfons  the  night  after 
they  returned  from  the  coarfe  diet  of  the  camp^ 
and  from  lleeping  upon  an  earthen  or  wooden  fioon 
Many  other  inflances  might  be  mentioned  of  fever 
being  brought  on  by  ordinary  fliimuli,  ailing  upon 
increafed  or  accumulated  excitability. 

This  conne6lion  of  excitability  with  debility,  has 
lately  been  pointed  out  by  the  French  phyficians  by 
the  terms  "  laxite  vibratile,*'  by  which  they  mean 
a  liablenefs  in  the  fyilem  to  be  thrown  into  vibra*' 
tions  or  motions  by  the  predifpolition  of  debility. 

That  this  vibratility,  or  difpofition  to  preterna* 
tural  motion  in  animal  matter,  is  the  predifpoling 
caufe  of  fevers,  is  evident  from  their  occurring  in 
thofe  flages  of  life  in  which  it  is  mofh  common,  as 
in  infancy,  childhood,  youth,  and  middle  life.  Fe- 
vers are  lefs  common  in  old  age,  for  the  vibra- 
tility  of  the  fanguiferous  fyilem,  in  which  I  fhall 
prefently  fay  the  proximate  caufe  of  ordinary  fevef 
is  feated,  generally  declines  in  old  people.  It  even 
leiTens  in  the  ikin,  as  appears  by  contrading  it  for 
half  a  minute  between  the  fingers. 

IV.  The  flimuli  which  are  the  remote  or  exciting 
caufes  of  fever,  a6t  in  a  manner  wholly  different 

I  froni 


1^6  ON    THE    PROXIMATE 

from  what  they  do,  upon  a  body  in  which  there  is 
tio  predifpofition  to  fever.  In  health  there  is  a  con- 
flant  and  jufl  proportion  between  the  degrees  of 
excitement  and  excitability,  and  the  force  of  flimuli. 
But  this  is  not  the  cafe  in  a  predifpofition  to  a  fe- 
ver. The  ratio  between  the  action  of  flimuli  and 
excitement,  and  excitability  is^  deftroyed  ;  and  hence 
the  former  act  upon  the  latter  with  a  force  which 
produces  irregulaf  action,  or  a  convulfion  in  the  ar- 
terial fyilem.  When  the  body  is  debilitated,  and 
its  excitability  increafed,  either  by  fear,  darknefs, 
or  filence,  a  fudden  noife  occafions  a  fhort  convul- 
fion. We  awake  in  like  manner  in  a  light  convul- 
fion, from  the  fudden  opening  of  a  door,  or  from 
the  fprinklrng  of  a  few  drops  of  water  in  the  face, 
after  the  excitability  of  the  fyilem  has  been  accu* 
mulated  by  a  night^s  fleep.  In  a  word,  it  feems  to 
be  a  law  of  the  fyilem  that  ilimulus,  in  an  over-pro- 
portion to  excitability,  either  produces  convulfion, 
or  goes  fo  far  beyond  it,  as  to  deflroy  motion  alto- 
gether in  death. 

V.  The  flimuli  which  induce  the  irregular  a^lion 
©r  convulfion  of  fever,  a£l,  for  the  mofl  part,  pri- 
marily upon  the  fanguiferous,  and  particularly  upon 
the  arterial  fyflem.  The  arteries  pervade  every 
part  of  the  body.  They  terminate  on  every  part 
ef  its  furface,  in  which  I  include  the  lungs  and  ali- 
mentary 


CAUSE    OF    FEVER.  1^| 

mentary  canal,  as  well  as  the  ikin.  It  is  from  this 
circumflance  that  they  are  fo  eafily  afFe^led  by  cold^ 
heat,  and  all  the  other  remote  and  exciting  caufes 
of  fever*  I  need  not  paufe  to  prove  that  the  blood- 
velTels  poiTefs  mufcular  fibres,  and  that  their  irrita- 
bility, or  difpofition  to  motion,  depends  upon  them. 
This  has  been  demonflrated  by  Dr.  Vaffchuer  and 
Mr.  John  Hunter  by  many  experiments.  Dr.  Boer- 
haave  admits  it  in  the  hiflory  he  has  given  in  his  In- 
ftitutes,  of  an  ox  that  was  killed  immediately  after 
it  had  been  violently  heated  by  running  away.  The 
coats  of  its  arteries  were  fuffufed  with  blood,  in 
confequence  of  inflammation.  Even  Dr.  Haller, 
who  denies  the  mufcularity  and  irritabihty  of  the 
blood- veflels,  implies  an  aflent  to  them  in  the  fol- 
lowing words :  "  There  are  nerves  which  defcend 
for  a  long  way  together  through  the  furface  of  the 
artery,  and  at  lafl  vanifh  in  the  cellular  fubflance  of 
the  veflel,  of  which  we  have  a  fpecimen  in  the  ex- 
ternal and  internal  carotids,  and  in  the  arch  of  the 
aorta ;  and  from  thefe  do  not  the  arteries  feem  to 
derive  a  mufcular  and  convulfive  force  very  different 
from  that  of  their  fimple  elaflicity  ?  Does  not  this 
ftiew  itfelf  plainly  in  fevers^  faintings,  pallies,  coni- 
fumption,  and  palfions  of  the  mind  ?''  * 

*  FIrfl  Lines,  f  32.  of  the  chapter  on  the  Arteries. 

I  2  The 


f^i  ON    THE    PROXIMATE 

The  morbid  a£lion  of  the  blood-veffels  difcovers 
jtfelf  in  preternatural  force  or  frequency  in  the  pul- 
fations  of  the  arteries.  In  this  flate  of  the  arteries, 
the  flomach,  bowels,  and  mufcles  exhibit  marks  of 
preternatural  weaknefs,  for  natural  excitement  is 
abflracled  from  them,  and  concentrated  in  the  fan* 
guiferous  fyftem. 

VI.  There  is  bat  one  remote  caufe  of  fever,  and 
that  is  flimulus.  Heat,  alternating  with  cold,  * 
marili  and  human  miafmata,  contagions  and  poifons 
of  all  kinds,  intemperance,  paJfTions  of  the  mind^ 
bruifes,  burns,  and  the  like,  all  a£l  by  a  flimulating 
power  only,  in  producing  fever.  This  proportion 
is  of  great  application,  inafmuch  as  it  cuts  the  fmews 
of  the  divillon  of  difeafes  from  their  remote  caufes. 
Thus  it  eftabliflies  the  famenefs  of  a  pleurify,  whe- 
ther it  be  excited  by  heat  fucceeding  cold,  or  by  the 
contagion  of  the  fmall-pox,  meafles,  or  yellow  fever. 

VII.  There  is  but  one  fever.  Hovv^ever  diiFerent 
the  predifpofmg,  remote,  or  exciting  caufes  of  fever 

*  Dr.  Sydenham  afcrlbes  nearly  all  fevers  to  this  caufe, 
particularly  to  leaving  off  winter  clothes  too  foon,  and  to  ex- 
pofing  the  body  to  cold  after  it  has  been  heated.  Thefe  two 
fources  of  fever,  he  adds,  deftroy  more  than  the  plague,  fword, 
jOT  faroinc. 

Wallis's  Edition,  Vol.  I.  p.  357. 

jnay 


CAUSE    OF    FEVER.  i:*-; 

may  be,  whether  dire<^  or  indire^l  debility,  whe^ 
ther  heat  or  cold  fucceeding  to  each  other,  whether 
marlli  or  human  miafmata,  whether  intemperance, 
a  fright,  or  a  fall,  (till  I  repeat,  there  can  be  but 
one  fever.  I  found  this  proportion  upon  all  the 
fuppofed  variety  of  fevers  having  but  one  proxi- 
mate caufe.  Thus  fire  is  an  unit,  whether  it  be 
produced  by  fri^lion,  percullion,  elecl:ricity,  fermen- 
tation, or  by  a  piece  of  wood  or  coal  in  a  flate  of 
■inflammation. 

VIII.  All  ordinary  fever  being  feated  in  the 
blood-vefleis,  it  follows  of  courfe,  that  all  thofe 
local  alfedions  we  call  pleurify,  angina,  phrenitis, 
internal  dropfy  of  the  brain,  pulmonary  confump- 
tion,  and  inflammation  of  the  liver,  flomach,  bowels, 
and  limbs,  are  fyraptoms  only  of  an  original  and 
primary  difeafe  in  the  fanguiferous  fyftem.  The 
truth  of  this  propofition  is  obvious,  from  the  above 
local  aifeclions  fucceeding  primary  fever,  and  from 
their  alternating  fo  frequently  with  each  other.  I 
except  from  this  remark  thofe  cafes  of  primary  af- 
fections of  the  vifcera  which  are  produced  by  local 
injuries,  and  which,  after  a  while,  bring  the  whole 
fanguiferous  fyflem  into  fympathy.  Thefe  cafes  are 
uncommon,  amounting  probably  to  not  more  than 
one  in  a  hundred  of  all  the  cafes  of  local  affc<flion 
which  occur  in  general  fever. 

I  3  Having 


134  ON    THE    PROXIMATE 

Having  premifed  thefe  general  propofitions,  I 
go  on  to  remark,  that  a  fever  (when  not  mifplaced") 
confills  in  a  morbid  excitement  and  irregular  action 
in  the  blood- vefTels,  more  efpecially  in  the  arteries. 
This  morbid  excitement,  or  irregular  aftion,  mani- 
fells  itfelf  to  the  fingers,  v^hen  prelTed  upon  the 
radial  artery,  by  preternatural  fulnefs,  force,  and 
frequency,  or  by  preternatural  flownefs,  intermif- 
iions  and  depreffion  in  what  are  called  inflammatory 
fevers,  and  by  preternatural  frequency  without  ful- 
nefs or  force,  in  what  are  called  typhus  fevers, 

I  have  called  the  aclion  of  the  arteries  irregular 
in  fever,  to  diftinguiih  it  from  that  excefs  of  action 
which  takes  place  after  violent  exercife,  and  from 
that  quicknefs  which  accompanies  fear  or  any  other 
diredly  debilitating  caufe.  The  adiion  of  the  arteries 
here  is  regular^  and  when  felt  in  the  pulfe,  affords  a 
very  different  perception  to  the  mind  from  that 
which  we  feel  in  the  pulfe  of  a  patient  labouring 
under  a  fever. 

This  irregular  a^lion  is  in  other  words,  a  con- 
vulsion in  the  fanguiferous,  but  more  obvioufly,  in 
the  arterial  fyilem. 

That  this  is  the  cafe  I  infer  from  the  flri^l  analogy 
between  fymptoms  of  fever,  and  convulfions  in  the 

nervous 


CAUSE    OF    FEVER..  .  Ij^j;. 

nervous  fyftem.     I  lliall  briefly  mention  the  partlcu-. 
lars  in  which  this  analogy  takes  place. 

1.  Are  convulfions  in  the  nervous  fyflem  pre- 
ceded by  debility  ?  So  is  the  convuliion  of  the  blood- 
vcffels  in  fever. 

2.  Does  debility  induced  on  the  whole,  or  on  a 
part  only,  of  the  nervous  fyflem,  predifpofe  to 
general  convulfions,  as  in  tetanus  ?  So  we  obferve 
debility,  whether  it  be  induced  on  the  whole  or  on 
a  part  of  the  arterial  fyflem,  predifpofes  to  general 
fever.  This  is  obvious  in  the  fever  which  enfues 
alike  from  cold  applied  to  every  part  of  the  body, 
or  irom  a  flream  of  cold  air  falling  upon  the  neck, 
or  from  the  wetting  of  the  feet. 

5.  Do  tremors  precede  convulfions  in  the  nervous 
fyflem  ?  So  they  do  the  convulfion  of  the  blood- 
vefTels  in  fever. 

4.  Is  a  coldnefs  in  the  extremities  a  precurfor 
of  convulfions  in  the  nervous  fyflem  ?  So  it  is  of 
fever. 

5.  Do  convulfions  in  the  nervous  fyflem  impart 
.a  jerking  fenfation  to  the  fingers  ?  So  does  the  con- 

I  4  vulfion 


13^  ON    THE    PROXIMATE 

vulfion  of  fever  in  the  arteries,  when  felt  at  the 
wriib. 

6.  Arc  conYulfions  in  the  nervous  fyftem  attended 
with  alternate  a£tion  and  remiffion  ?  So  is  the  con- 
vulfion  of  fever. 

7.  Do  convulfions  in  the  nervous  fyflem  return 
at  regular  and  irregular  periods  ?  So  does  fever. 

8.  Do  convulfions  in  the  nervous  fyftem,  under 
certain  circumftances,  affeft  the  functions  of  the 
brainf  So  do  certain  flates  of  fever. 

9.  Are  there  certain  convulfions  in  the  nervous 
fyllem  which  affe£l  the  limbs,  without  aifefting  the 
fun£Hons  of  the  brain,  fuch  as  tetanus,  and  chorea 
fanfli  Viti  ?  So  there  are  certain  fevers,  particularly 
the  common  he<^ic,  which  feidom  produces  delirium 
or  even  head  ach,  and  frequently  does  not  confine 
a  patient  to  his  bed, 

10.  Are  there  local  convulfions  in  the  nervous 
fyflem,  as  in  the  hands,  feet,  neck,  and  eye-lids  ? 
So  there  are  local  fevers.  Intermittents  often  appear 
in  the  autumn  with  periodical  heat  and  pains  in  the 
eyes,  ears,  jaws,  and  back, 

II,  Are 


CAUSE    OF    FEVER,  *"       I37 

11.  Are  there  certain  grades  in  the  convulfions  of 
the  nervous  fyftem,  as  appears  in  the  hydrophobia, 
tetanus,  epilcpfy,  hyfteria  and,  hypochondriacs  ?  So 
there  are  grades  in  fevers,  as  in  the  plague,  yellow 
fever,  fmall-pox,  rheumatifm,  and  common  remitting 
and  intermitting  fevers. 

12.  Are  nervous  convulfions  moll  apt  to  occur  ii! 
infancy  ?  So  are  fevers. 

13.  Are  perfons  once  afFefted  with  nervous  con- 
vulfions, frequently  fubje£l  to  them  through  lifer 
So  are  perfons  once  aiFefted  with  fever.  The  inter- 
mitting fever  often  returns  with  fuccelTive  fprings  or 
autumns,  and  in  fpite  of  the  bark,  fometimes  con- 
tinues for  many  years  in  all  climates  and  feafons* 

1 4.  Is  the  ftrength  of  the  nei'vous  fyilem  increafed 
by  convulfions  ?  This  is  fo  evident,  that  it  often  re- 
quires four  or  Rye  perfons  to  confine  a  delicate 
woman  to  her  bed  in  a  convulfive  fit.  In  like  man- 
ner the  flrength  of  the  arterial  fyflem  is  increafed  in 
a  fever.  This  ftrength  is  great  in  proportion  to  the 
weaknefs  of  every  other  part  of  the  body. 

15.  Do  we  obferve  certain  nervous  convulfions 
to  aife^l  fome  parts  of  the   nervous  fyftem  more 
than  others,  or  in  other  words,  do  we  obferve  pre- 
ternatural 


138  ON    THE    PROXIMATE 

ternatural  flrength  or  excitement,  to  exifl  in  one 
pai't  of  the  nervous  fyllem,  while  other  parts  of 
tlie  fame  fyflem  exhibit  marks  of  preternatural 
weaknefs,  or  defe^l  of  excitement  ?  We  obferve 
the  fame  thing  in  the  blood- veiTels  in  a  fever.  The 
pulfe  at  the  wrifl  is  often  tenfe^  while  the  force 
of  the  heart  is  very  much  diminillied.  A  delirium 
often  occurs  in  a  fever  from  excefs  of  excitement  in 
the  blood-velTels  of  the  brain,  while  the  pulfe  at  the 
wrifl  exhibits  every  mark  of  preternatural  weak- 
nefs, 

16.  Is  there  a  rigidity  of  the  mufcles  in  certain 
nervous  difeafes,  as  in  catalepfy  ?  Something  like 
this  folftice  in  convulfion  occurs  in  that  flate  of  fever 
in  which  the  pulfe  beats  but  60,  or  fewer  ftrokes  in 
a  minute. 

17.  Do  convullions  go  off  gradually  from  the 
nervous  fyftem,  as  in  tetanus,  and  chorea  fan£i:i  Viti  ? 
So  they  do  from  the  arterial  blood-velTeis  in  certain 
Hates  of  fever. 

18.  Do  convulfions  go  o^  fuddenly  in  any  cafes 
from  the  nervous  fyftem  ?  The  convulfion  in  the 
"blood- veffels,  goes  off  in  the  fame  manner  by  a 
fweat,  or  by  an  hjemorrhage,  frequently  in  the 
foiirfe  of  a  night,  and  fometimes  in  a  fmgle  hour. 

19.  Does 


CAUSE    OF    FEVER.  1 39 

19.  Does  palfy  in  fome  inflances  fucceed  to  con- 
vulfions  in  the  nervous  fyftem  ?  Something  like  a 
palfy  occurs  in  the  blood-veffels  in  fevers  of  great 
inflammatory  aftion.  I  fliall  hereafter  afcribe  the 
diflblved  appearance  of  the  blood  in  malignant  fevers 
to  this  tendency  of  the  blood-veflTels  to  a  paralytic 
ftate.  It  begins  in  the  veins  in  which  mufcular  aftion 
is  more  feeble  than  in  the  arteries.  This  has  been 
proved  by  Dr.  Mitchell  in  his  account  of  the  yellow 
fever  in  Virginia  in  the  year  1741.  He  found  the 
blood  to  be  diflblved  when  drawn  from  the  veins ^ 
"Vi^hich  when  drawn  from  the  arteries  of  the  fame 
perfons,  exhibited  no  marks  of  difTolution.  This  faft 
is  of  great  importance  in  medicine,  as  I  hope  to 
fliew  when  I  come  to  treat  of  blood-letting. 

From  the  fa£i:s  and  analogies  which  have  been 
mentioned,  I  have  been  led  to  believe  that  irregular 
a£l:ion  or  a  convulfion  in  the  blood-veffels,  is  the 
proximate  caufe  of  fever. 

There  is  a  wonderful  frugality  in  the  operations 
of  nature.  Two  inilruments  are  never  employed 
by  her  to  accomplifli  that  which  can  be  effeded  by 
one.  As  the  predifpofmg  and  remote  caufes  of  all 
general  difeafes  are  fimple,  fo  is  the  proximate.  My 
theory  of  fever  then  refolves  itfelf  into  a  chain,  con- 
filling  of  four  links,      i .  Predifpofmg  debility,   or 

weakened 


i40  ON    THE    PROXIMATE 

weakened  excitement  of  the  blood-velTels.  2.  An 
increafe  of  their  excitability.  3.  Stimulating  powers 
applied  to  them.  And,  4.  Irregular  a^lion  or  con- 
vuliion. 

I  might  digrefs  here,  and  fliew  that  all  difeafes, 
whether  they  be  feated  in  the  arteries,  mufcles, 
nerves,  brain,  or  alimentary  canal,  are  all  preceded 
by  debility  ;  and  that  their  efience  confifts  in  irre- 
gular aftion,  or  in  the  abfence  of  the  natural  order 
of  motion,  produced  or  invited  by  prcdifpofmg  de- 
bility. Hence  they  have  very  properly  been  called 
DISORDERS.  I  might  further  fliew,  that  all  the 
moral  as  well  as  phyfical  evil  of  the  world  confifls 
in  predifpofmg  v/eaknefs,  and  in  fubfequent  de- 
rangement of  action  or  motion  ;  but  thefe  collateral 
fubjecls  are  foreign  to  our  prefent  inquiry. 

Let  us  now  proceed  to  examine  how  far  the 
theory,  which  ha^  been  delivered,  accords  with  the 
phenomena  of  fever. 

I  fliall  divide  thefe  phenomena  into  two  kinds. 

I.  Such  as  are  tranfient,  and  more  or  lefs  com- 
mon to  all  fevers.      Thefe  I  fliall  call  fymptoms  of 


fever. 


II.  Such 


CAUSE    OF    FEVER.  I4I 

IL  Such  as,  being  more  permanent  and  fixed, 
have  given  rife  to  certain  fpecific  names.  Thefe  I 
ihall  czWjlaUs  of  fever. 

I  fliall  endeavour  to  explain  and  defcribe  each  of 
them  in  the  order  in  which  they  have  been  men- 
tioned. 

I.  Laffitude  is  the  natural  efFe6l  of  the  predif- 
pofmg  debility  which  precedes  fever. 

Coidnefs  and  chills  are  the  efFecls  of  the  abflrac- 
tion  of  excitement,  or  natural  motion  from  the  fur- 
face  of  the  body.  The  abfencc  of  chills  indicates 
the  fenfibility  of  the  external  parts  of  the  body  to 
be  fufpended  or  deilroyed,  as  well  as  their  irrita- 
bility ;  hence  where  death  occurs  in  the  fit  of  an 
intermittent,  there  is  no  chill.  A  chilly  fit,  for  the 
fame  reafon,  feldom  occurs  in  the  moil  malignant 
cafes  of  fever.  It  has  been  remarked,  that  the 
chilly  fit,  in  common  fevers,  feldom  appears  in  its 
full  force  until  the  patient  approaches  a  fire,  or  lies 
down  in  a  warm  bed  ;  for  in  thefe  fituations  the  fen- 
fibility of  the  fyfi:em  is  refi:ored  by  the  fi:imulus  of 
the  heat  ailing  upon  the  extremities  of  the  blood- 
vefifels.  It  is  produced  in  a  mechanical  manner,  and 
is  by  no  means  the  effe^i:  of  an  effort  of  the  healing- 
powers  of  nature  to  fave  the  fyflem  from  defi;ru(^ion. 

Tremors 


142  ON    THE    PROXIMATE 

Tremors  are  the  natural  confequence  of  the  ab- 
flra^lion  of  that  fupport  which  the  mufcles  receive 
from  the  fulnefs  and  tenfion  of  the  blood- veiTels. 
It  is  from  this  retreat  of  the  blood  towards  the  vif- 
cera,  that  the  capillary  arteries  lofe  their  fulnefs  and 
tenfion  ;  hence  they  contraft  like  other  foft  tubes 
that  are  emptied  of  their  contents.  This  contraction 
has  been  called  a  fpafm,  and  has  improperly  been 
fuppofed  to  be  the  proximate  caufe  of  fever.  From 
the  explanation  that  has  been  given  of  its  caufe,  it 
appears  like  the  coldnefs  and  chills,  to  be  nothing 
but  an  accidental  concomitant  or  effed  of  a  pa- 
roxyfm  of  fever. 

The  local  pains  in  the  head,  breafl,  and  bones  in 
fever,  appear  to  be  the  eifects  of  the  irregular  de- 
termination of  the  blood  to  thofe  parts,  and  to  mor- 
bid aflion  being  thereby  induced  in  them. 

The  vomiting  and  diarrhoea  are  produced  by  mor- 
bid excitem.ent  in  the  veflels  of  the  ftomach  and 
bov/els- 

The  want  of  appetite  and  coflivenefs  are  the  con- 
fequences  of  a  defect  of  excitement  or  natural  ac- 
tion in  the  fame  parts  of  the  body. 


The 


CAUSE    OF    FEVER.  14^ 

The  dry  fkin  or  partial  fweats  appear  to  depend 
Hpon  dimlniflied  or  partial  action  in  the  velTelg 
which  terminate  on  the  furface  of  the  body. 

The  high  coloured  and  pale  urine,  are  occafioned 
by  an  excefs  or  a  deficiency  of  excitement  in  the 
fecretory  vefTels  of  the  kidneys. 

The  fuppreflion  of  the  urine  feems  to  arife  from 
what  Dr.  Clark  calls  an  engorgement,  or  choaking 
of  the  velTels  of  the  kidneys.  It  occurs  moil  fre- 
quently in  malignant  fevers. 

Thirfl  is  probably  the  efFe^l:  of  a  preternatural 
excitement  of  the  veiTels  of  the  fauces.  It  is  by 
no  means  an  uniform  fymptom  of  fever.  We  fome- 
times  obferve  it  in  the  highefl  degree,  in  the  iaft 
flage  of  difeafes,  induced  by  the  retreat  of  the  lafl 
remains  of  excitement  from  every  part  of  the  body^ 
to  the  throat. 

The  white  tongue  is  produced  by  a  change  in 
the  fecretion  which  takes  place  in  that  organ.  Its 
yellow  colour  is  the  effect  of  bile  j  its  drynefs,  is 
occafioned  by  an  obflru^tion  of  fecretion  ;  and  its 
dark  and  black  colour,  by  a  tendency  to  mortifica- 
tion. 


It 


144  ON    THE    PROXIMATE 

It  will  be  difficult  to  account  for  the  variety  In 
the  degrees  and  locality  of  heat  in  the  body  in  a 
fever,  until  we  know  more  of  the  caufe  of  animal 
heat.  From  whatever  caufe  it  be  derived,  its  excefs 
and  deficiency,  as  well  as  all  its  intermediate  de- 
grees, are  intimately  conne£led  with  more  or  lefs 
excitement  in  the  arterial  fyilem.  It  is  not  neceffary 
that  this  excitement  fliould  exifl  only  in  the  large 
blood-veifels.  It  will  be  fufficient  for  the  purpofc 
of  creating  great  heat,  if  it  occur  only  in  the  cuta- 
neous velTels ;  hence  we  find  a  hot  ikin  in  fome 
cafes  of  malignant  fever  in  which  there  is  an  ab- 
fence  of  pulfe,  A  defecl  of  excitement  produced 
by  great  excefs  of  flimulus,  as  in  the  firfl  flage  of 
violent  malignant  fevers,  is  often  accompanied  by  a 
deficiency  of  heat,  and  in  fome  inftances  by  a  cold- 
nefs  on  the  furface  of  the  body.  In  thefe  cafes 
there  is  a  defe61:  of  excitement  in  the  vefiels  of  the 
Jlcin  as  well  as  in  the  larger  blood-vefi!els.  Local 
heat,  whether  in  the  head,  breaft,  hands,  or  feet, 
I  fuppofe  to  be  the  ^ffeci:  of  local  excitement. 

Eruptions  feem  to  depend  upon  efiufions  of  fe* 
rum,  lymph,  or  red  blood  upon  the  ilcin,  with  or 
without  inilammaticn,  in  the  cutaneous  veifels. 

I  decline  taking  notice  in  this  place  of  the  fame* 
D.efs  of  the  fymptoms  which  are  produced  by  in- 

4  direct 


CAUSE    OF    FEVER.  I45 

dire£i:  and  dlre<ft  debility  in  the  fyftem.  They  ap- 
pear not  only  in  the  temperature  of  the  body,  but 
in  all  the  different  fymptoms  of  fever.  It  is  of  im- 
portance to  know  when  they  originate  from  the 
former,  and  when  from  the  latter  dates  of  debility, 
as  they  require  very  different  and  oppofite  remedies 
to  remove  them. 

It  remains  only  to  explain  the  caufe,  w^hy  excefs 
in  the,  force  or  frequency  of  the  a£i:ion  of  the 
blood-veffels  fliould  fucceed  debiHty  in  a  part,  or 
in  the  whole  of  the  body,  and  be  connected  for  days 
^nd  weeks  with  preternatural  debility  in  the  muf- 
cles,  nerves,  brain,  and  alimentary  canal.  I  fhall 
attempt  the  explanation  of  this  phenomenon  by 
diredling  the  attention  of  the  reader  to  the  opera- 
tions of  nature  in  other  parts  of  her  works. 

1.  A  calm  may  be  confidered  as  a  flate  of  de- 
bility in  the  atmofphere.  It  predifpofes  to  a  cur- 
rent of  air.  But  is  this  current  proportioned  to 
the  lofs  of  the  equilibrium  of  the  air  ?  By  no  means  : 
It  is  exceffive  in  its  force,  and  tends  thereby  to  de-^ 
flroy  the  works  both  of  nature  and  art. 

2.  The  paffions  are  given  to  man  on  purpofe  to 
aid  the  flow  and  uncertain  operations  of  reafon* 
But  is  their  action  always  proportioned  to  the  caufes 
which  excite  them?  An  acute  pneumony  brought 

K  on 


146  ON    THE    PROXIMATE 

on  by  the  trifling  injury  done  to  the  fyflem  by  the 
fatigue  and  heat  of  an  evening  fpent  in  a  dancing 
aflembly,  is  but  a  faint  reprefentation  of  the  im- 
menfe  difproportion  between  a  trifling  affront,  and 
that  excefs  of  paflion  which  feeks  for  gratification  in 
poifon,  aflafllnation,  or  a  duel.  The  fame  difpropor- 
tion appears  between  caufe  and  effbft  in  pubHc  bo- 
dies. A  hafty  word  of  no  mifchievous  influence, 
has  often  produced  convulfions,  and  even  revolu- 
tions, in  ftates  and  empires. 

If  we  return  to  the  human  body,  we  fhall  find  in 
it  many  other  inflances  of  the  difproportion  between 
ftimulus  and  aftion,  befides  that  which  takes  place 
in  the  exciting  and  proximate  caufe  pf  fever, 

3.  A  fingle  caftor  oil  nut,  although  rejected  by 
the  ilomach  upon  its  firfl  eflbrt  in  vomiting,  has,  in 
one  inflance  that  came  within  my  knowledge,  pro- 
duced a  vomiting  that  continued  nearly  twenty-four 
hours.     Here  the  duration  of  a^lion  was  far  beyond 

all  kind  of  proportion  to  the  caufe  which  excited  it, 

» 

4.  A  grain  of  fand,  after  being  wafhed  from 
the  eye,  is  often  followed  by  fuch  an  iliflammation, 
or  excefs  in  the  a^lion  of  the  veflfels  of  the  eye,  as 
to  require  bleeding,  purging,  and  bliftering  to  re- 
move it. 

Could 


CAUSE    OF    FEVER,  I47 

Could  we  comprehend  every  part  of  the  fublime 
and  ineffable  fyflem  of  the  natural,  moral,  and  po- 
litical government  of  the  world,  I  am  fure  we  ftiould 
dilcover  nothing  in  it,  but  what  tended  ultimately 
to  order  and  happinefs.     But   there  is  evil  in  the 
world,  and  the  operations  of  nature,  which  were 
originally  the  minifters  of  goodnefs  only  to  man, 
are  in  many  inilances  the  vehicles  of  this  evil.     In 
religion  and  morals,  as  well  as  in  medicine,  nature 
leads  to  error  and  deflruftion.     When  we  worlliip 
the  fun,  a  cat,  a  crocodile,  or  the  devil,  we  follow 
nature.     When  we  lie,  fleal,   and  commit  murder 
and  adultery,  we  follow  nature.      In  like  manner, 
when  we  indulge  every  appetite  and  paiTion  of  our 
patients  in  ficknefs,  and  create  hcemorrhages,  ob- 
llru£iions,  dropfies,  pallies,   apoplexies*,  and  death, 
by  neglecting  bleeding  and  purging  in  fevers,  we 
follow  nature.     But  while  I  maintain  this  unufual 
language  in  medicine,   let  it  be  remembered,  that 
the    operations  of  nature  were  not  originally  the 
means  of  feducing  or  injuring  man  ;  and  Revelation 
affures  us,  that  a  time  will  come,  when  the  dominion, 
of  order  ihall  be  reftored  over  every  action  of  his 
body  and  mind,  and  health  and  happincfs  again  be 
the  refult  of  every  movement  of  nature. 

From  the  view  I  have  given  of  the  ftate  of  the 
blood-veffels  in  fever,  the  reader  will  perceive  the 

K  2  difference 


148  ON    THE    PROXIMATE 

diiFerence  between  my  opinions  and  Dr.  Brown^s 
upon  this  fubjeft.  The  Do£kor  fuppofes  a  fever  to 
conlift  in  debility.  I  do  not  admit  debility  to  be  a 
difeafe,  but  place  it  wholly  in  morbid  excitement, 
invited  and  fixed  by  previous  debility.  He  makes 
a  fever  to  confift  in  a  change  only  of  a  natural 
action  of  the  blood-veflels.  I  maintain  that  it  con- 
fifts  in  a  preternatural  and  convulfive  aftion  of  the 
blood-veffels.  Laflly,  Dr.  Brown  fuppofes  excite- 
ment and  excitability  to  be  equal  in  fever.  My 
theory  fuppofes  a  fever  to  be  the  reverfe  of  this. 
It  confifts  in  unequal  or  divided  excitement  and  ex- 
citability. Health  confifts  in  the  equality  and  uni* 
formity  of  them  both  ;  and  the  bufmefs  of  medi- 
cine, as  I  fliall  fay  hereafter,  is  to  equalize  them  in 
the  cure  of  fever  ;  that  is,  to  abilra<^  their  excefs 
from  the  blood-veffels,  and  to  reft  ore  them  to  the 
other  parts  of  the  body. 

It  belongs  to  this  part  of  our  view  of  fever  to 
repeat  from  Dr.  Boerhaave,  that  its  termination  is 
always  in  health,  in  another  difeafe,  or  in  death. 
A  flight  fever  only  can  terminate  in  health.  All 
fevers  of  violent  action,  when  left  to  themfelves,  or 
when  partially  cured,  terminate  in  other  difeafes, 
or  in  death*  The  laft  is  the  effect  of  the  fmgle  or 
combined  operation  of  the  following  caufes :  i.  Ef- 
fufions  in  parts  effential  to  life.     2.  Such  a  change 

being 


CAUSE   OF    FEVER,  j^c) 

being   induced   in    the  excretions,  by  the  violent 
action  of  the  veiTels  upon  the  blood,  as  to  render 
them  deftruiflive  to  the  organs  of  the  body.     3.  The 
inability  of  the  fyllem,  from  univerfal  direct  debi- 
lity, to  receive  imprelTions,  or  to  fupport  the  mo- 
tions of  life.      Or  lailly,  death  from  fever  is  the 
-efFefi:  of  the  combined  operation  of  all  the  three 
caufes  that  have  been  mentioned.     I  cannot  difmifs 
the  blood-veflels,  as  the  feat  of  a  general  and  fre- 
quent difeafe,  without  lamenting  that  their  phyfio- 
logy  and  pathology  have  been  fo  little  fludied  by 
phyficians.     They  are  the  firft  born  parts  of  the  hu- 
man  body  ;  they  fupport,  in  a  great  meafure,  the 
fecfibility   and  irritability  of  the   nervous  fyflem ; 
they  are  the  centinels  of  the  whole  fyflem  in  ileep  ; 
and,  they  are  the  lafl  retreat  of  departing  life. 

11.  I  come  now  to  apply  the  theory  which  I  have 
delivered,  to  the  explanation  and  defcription  of  the 
different  phenomena  or  flates  of  fever. 

I  have  faid  that  there  is  but  one  fever.  Of  courfe 
I  do  not  admit  of  its  artificial  divifion  into  genera 
and  fpecies.  A  difeafe  which  fo  frequently  changes 
its  form  and  place,  fhould  never  have  been  delig- 
nated,  like  plants  and  animals,  by  unchangeable  cha- 
r adders.  The  oak  tree  and  the  lion  polTefs  exadlly  the 
fame  properties  which  they  did  near  6000  years  ago. 

K  3  But 


150  ON   THE    PROXIMATE 

But  who  can  fay  the  fame  thing  of  any  one  difeafe  ? 
The  pulmonary  confumption  is  fometimes  transform- 
ed into  head  ach,  rheumatifm,  diarrhoea,  cind  mania, 
in  the  courfe  of  two  or  three  months,  or  the  fame 
number  of  weeks.     The  biHous  fever  often  appears 
in  the  fame  perfon  in  the  form  of  colic,  dyfentery, 
inflammation  of  the  liver,  lungs,  and  brain,  in  the 
courfe  of  {ivQ  or  fix  days.     The  hypochondriafis  and 
the  hyfteria  feldom  fail  to  exchange  their  fymptoms 
twice  in  the  four-and-twenty  hours.      Again  :    The 
oak  tree  has  not  united  with  any  of  the  trees  of  the 
foreft,  nor  has  the  lion  imparted  his  fpecific  qua- 
lities to  any  other  anim.aL     But  who  can  apply  fimi- 
lar  remarks  to  any  one  difeafe  ?  Phrenitis,  gaflritis, 
enteritis,  nephritis,   and  rheumatifm,  all  appear  at 
the  fame  time  in  the  gout  and  yellow  fever.     Many 
obfervations  of  the  fame  kind  might  be  made  upon 
all  other  difeafes.      To  defer ibe  them  therefore  by 
any  fixed  or  fpecific  charaders,  is  as  impradlicable  as 
to  meafure  the  dimenfions  of  a  cloud  on  a  windy 
day,  or  to  {ix   the  component  parts  of  water  by 
weighing  it  in  a  hydroftatic  balance.     Much  mifchief 
has  been  doneby  nofological  arrangements  of  difeafes. 

They  ere£l:  imaginary  boundaries  between  things 
which  are  of  a  homogeneous  nature.  They  de- 
grade the  human  underflanding,  by  fubflituting 
fimple  perceptions,  to  its  more  dignified  operations 

of 


CAUSE    OF    FEVER.  .  155: 

of  judgment  and  reafoning.  They  gratify  Indolence 
In  a  phylician,  by  fixing  his  attention  upon  the 
name  of  a  difeafe,  and  thereby  leading  him  to  ne- 
gleft  the  varying  ftate  of  the  fyftem.  They  more- 
over lay  a  foundation  for  difputes  among  phyficians, 
by  diverting  their  attention  from  the  fimple  predif- 
pofing  and  proximate,  to  the  numerous,  remote, 
and  exciting  caufes  of  difeafes,  or  to  their  more  nu- 
merous and  complicated  effe(5i:s.  The  whole  materia 
medica  is  infected  with  the  baneful  confequences  of 
the  nomenclature  of  difeafes ;  for  every  article  in 
it  is  pointed  only  againfl  their  names,  and  hence 
the  origin  of  the  numerous  contradiftions  among 
authors  who  defcribe  the  virtues  and  dofes  of  the 
fame  medicines.  By  the  rejedlion  of  the  artificial 
arrangement  of  difeafes,  a  revolution  mufl  follow 
in  medicine.  Obfervation  and  judgment  will  take 
the  place  of  reading  and  memory,  and  prefcriptions 
will  be  conformed  to  exifling  circumftances.  The  road 
to  knowledge  in  medicine  by  this  means  will  likewife 
be  fhortened  ;  fo  that  a  young  man  will  be  able  to 
qualify  himfelf  to  practice  phy fie  at  as  much  lefs  ex- 
penfe  of  time  and  labour  than  formerly,  as  a  child 
would  learn  to  read  and  write  by  the  help  of  the 
Roman  alphabet,  inflead  of  Chinefe  charadlers. 

In  thus  reje£l:ing  the  nofologies  of  the  fchools, 
1  do  not  wifli  to  fee  them  banifhed  from  the  libra- 

K4  ries 


1^2  ON    THE    PROXIMATE 

ries  of  phyficians.  When  confulted  as  hiftories  of 
the  effects  of  difeafes  only,  they  may  ilill  be  ufefuL 
I  ufe  the  term  difeafes,  in  conformity  to  cuflom,  for 
properly  fpeaking,  difeafe  is  as  much  a  unit  as  fever. 
It  Gonfifls  fmiply  of  morbid  action  or  excitement  in 
fome  part  of  the  body.  Its  different  feats  and  de- 
grees, fliould  no  more  be  multiplied  into  different 
difeafes,  than  the  numerous  and  different  effedts  of 
heat,  and  light  upon  our  globe  fhould  be  multiplied 
into  a  plurality  of  funs. 

The  advocates  for  Dr.  Cullen's  fyflem  of  medi- 
dicine,  will  not,  I  hope,  be  offended  by  thefe  obfer- 
vations.  His  immenfe  flock  of  reputation,  will 
enable  him  to  fuflain  the  lofs  of  his  nofology,  without 
being  impoveriflied  by  it.  In  my  attempts  to  in* 
troduce  a  new  arrangement  of  difeafes,  I  fliall  only 
give  a  new  diredlion  to  his  efforts  to  improve  the 
healing  art. 

1  have  confidered  morbid  adlion  in  the  blood- 
veffels,  whether  it  confifl  in  preternatural  force  and 
frequency,  or  preternatural  force  without  frequency, 
or  frequency  without  force,  to  conflitute  the  proxi- 
mate caufe  of  fever.  Excefs  in  the  force  and  fre- 
quency of  the  blood- veffels,  has  been  confidered  as 
the  charafteriflic  mark  of  what  is  called  inflam- 
matory fever.  But  there  are  marks  which  indicate 
a  much  greater  excefs  of  flimulus  upon  the  blood- 

veffels* 


CAUSE    OF    FEVER.  l^j 

veffels.  Thefe  are  preternatural  flownefs,  inter- 
miflions  and  depreffion  in  the  pulfe,  fuch  as  occur 
in  certain  malignant  fevers.  In  applying  my  theory 
of  fever  to  the  explanation  of  all  its  different  flates, 
I  am  leu  by  this  view  of  its  inflammatory  flate,  to 
confider  them  in  the  order  of  their  inflammatory 
chara^iicr,  or  according  to  the  force  of  flimulus 
which  a^ls  upon  the  blood- veflTels.  The  following 
appears  to  be  the  ufual  order  of  inflammatory 
diathefis,  prefented  to  us  by  nature,  in  the  diiFerent 
fevers  which  are  defcribed  by  authors  ; 

1.  The  plague. 

2.  The  yellow  fever. 

3.  The  natural  fmail-pox. 

4.  The  malignant  fore  throat. 

5.  The  fever  from  the  alternate  aftion  of  cold 
and  heat  on  the  body,  appearing  with  the  fymp- 
toms  of  pleurify,  rhumatifrn,  tonic  gout,  internal 
dropfy  of  the  brain,  and  pulmonary  confumption. 

6.  The  meafles. 

7.  Catarrh  from  cold,  and  influenza  from  con- 
tagion. 

8.  The  common  remitting  fever,  appearing  oc- 
caflonally  with  the  fymptoms  of  colic,  dyfentery, 
inflammation  of  the  liver,  and  internal  dropfy  of 

(he  brain. 

9.  The  fcarlatina,  puerperilc  and  hedlic  fevers. 

I  o.  The 


154  ON    THE    PROXIMATE 

I  c.  The  jail  fever. 

1 1 .  The  common  mild  intermittent. 


This  fcale  of  the  degrees  of  morbid  a£lion  in 
fevers  is  taken  from  their  ufual  fymptoms.  They 
vary  with  climate,  feafon,  and  habit.  There  are  in- 
termittents,  jail,  and  puerperile  fevers,  fo  inflam- 
matory as  to  require  frequent  bleedings  to  cure 
them  ;  and  there  are  cafes  of  plague,  yellow  fever, 
and  pleurify,  which  yield  to  a  fmgle  dofe  of  purging 
phyfic.  It  is  upon  the  account  of  this  want  of 
uniformity  in  the  charafter  of  fevers,  and  the  in- 
fluence of  climate,  feafon,  and  habit  upon  them,  that 
I  fliall  follow  Dr.  Clark,  by  fubflituting  in  the  place 
of  their  ufual  names,  certain  definite  ftates  which 
may  be  applied,  with  varying  circumflances,  to  them 
all. 

1 .  I  fliall  divide  them  into  fuch  as  aife£l:  the  whole 
arterial  fyfliem,  with  no,  or  but  little  local  afle£l:ion. 

2.  Into  fuch  as  aiteft  the  whole  arterial  fyfliem, 
and  are  accompanied  at  the  fame  time  with  evident 
local  affections.     And, 

3.  Into  fuch  as  appear  to  pafs  by  the  arterial 
fyftem,  and  to  fix  themfelves  upon  other  parts  of 

the 


CAUSE    OF    FEVER.  i^^ 

the   body.      Thefe    ftates    of   fever    I    Ihall    call 
mi/placed. 

I.  I  fliall  begin  under  the  firil  head,  with  the 
MALIGNANT  Hate  of  fcver.  It  confhitutes  the 
highefl  grade  of  inflammatory  diatheiis.  It  is  known 
by  attacking  frequently  without  a  chilly  fit,  by 
coma,  a  deprefled,  flow,  or  intermitting  pulfe,  and 
fometimes  by  a  natural  temperature  or  coldnefs  of 
the  flcin.  It  occurs  in  the  plague,  in  the  yellow 
fever,  in  the  gout,  and  in  the  fmall-pox.  Dr.  Quier 
has  defcribed  a  pleurify  in  Jamaica,  in  which  fome  of 
thofe  malignant  fymptoms  took  place.  They  are 
the  efFe£l:  of  fuch  a  degree  of  fliimuius  as  to  profl:rate 
the  arterial  fyfl:em,  and  to  produce  a  defeat  of  adtion 
from  an  excefs  of  force.  Such  is  this  excefs  of  force 
in  fome  infl:ances  in  this  fl:ate  of  fever,  that  it  induces 
general  convulflons,  tetanus,  and  palfy,  and  fome- 
times extinguiflies  life  in  a  few  hours  by  means  of 
apoplexy  or  fyncope.  The  lefs  violent  degrees  of 
flimulus  in  this  fl:ate  of  fever  produce  palfy  in  the 
blood-veflTels.  It  probably  begins  in  the  veins,  and 
extends  gradually  to  the  arteries.  It  feems  further 
to  begin  in  the  extremities  of  the  arteries,  and  to 
extend  by  degrees  to  their  origin  in  the  heart.  This 
is  evident  in  the  total  abfence  of  pulfe  which  fome- 
times takes  place  in  malignant  fevers  four-and- 
twenty,  and  even   eight  and   forty  hours   before 

death. 


15^  ON    THE    PROXIMATE 

death.  But  there  are  cafes  in  which  this  paify 
affects  both  the  veins  and  arteries  at  the  fame  time. 
It  is  probably  from  this  fimultaneous  affection  of  the 
blood- veffels,  that  the  arteries  are  found  to  be  nearly 
full  of  blood  after  death  from  malignant  fevers* 
The  depreffed,  and  intermitting  pulfe  which  occurs 
in  the  beginning  of  thefe  fevers  perhaps  depends 
upon  a  tendency  to  palfy  in  the  arteries  indepen- 
dently of  an  affection  of  the  heart  or  brain. 

This  deprejfed  ffate  of  fever  more  frequently  when 
left  to  itfelf  terminates  in  petechise,  buboes,  car- 
buncles, abfceffes  and  mortifications,  according  as 
ferum.,  lymph,  or  red  blood  is  effufed  in  the  vifcera 
or  external  parts  of  the  body.  Thefe  morbid  ap- 
pearances have  been  afcribed  to  putrefa^ion,  and 
the  fever  has  received,  from  its  fuppofed  prefence, 
the  name  of  putrid.  The  exiftence  of  putrefaiStion 
in  the  blood  in  a  fever  is  rendered  improbable, 

I .  By  Dr.  Seybert's  experiments  '^  which  prove 
that  it  does  not  take  place  in  the  blood  in  a  living 
ilate.  It  occurs  in  the  excretions  of  bile,  fceces, 
and  urine,  but  in  this  cafe  it  does  not  -aB.  as  a  fer- 
ment, but  a  flimulus  only  upon  the  living  body. 

*  Inaugural  diiTertation  entitled,  <<  An  Attempt  to  dtfprove 
the  putrefa^f^ionofthe  blood  In  living  animals.'* 

2.  B7 


CAUSE    OF    FEVER.  l^y 

2.  By  Cmilar  appearances,  with  thofe  which  have 
been  afcribed  to  putrefaction,  having  been  produced 
by  hghtning,  by  violent  emotions  of  the  mind,  by 
extreme  pain,  and  by  every  thing  eU'e  which  Induces 
fudden  and  univerfal  diforganifation  in  the  fluids  and 
foiids  of  the  body.  To  the  faCts  mentioned  in  a 
former  work,*  with  a  view  of  refuting  the  opinion 
of  putrefaction  taking  place  in  the  blood,  I  fliall  add 
fome  others,  which  clearly  prove  that  the  fymxptoms 
which  have  been  fuppofed  to  defignate  a  putrid 
fever,  are  wholly  the  effecl  of  mechanical  aftion  in 
the  blood-veflels,  and  are  unconne6led  with  the  in- 
trodudlion  of  a  putrid  ferment  into  the  blood. 

Hippocrates  relates  the  cafe  of  a  certain  Antiphil- 
lus,  in  whom  a  putrid  bilious  fever  (as  he  calls  it) 
was  brought  on  by  the  application  of  a  cauftic  to  a 
wound.f 

An  acute  pain  in  the  eye,  Dr.  Phyfick  inform- 
ed me,  produced  what  are  called  the  fymptoms  of 
a  putrid  fever,  which  terminated  in  death  in  five 
days,  in  St.  George's  hofpitalin  the  year  1789. 

Dr.  Defportes  takes  notice  that  a  fifli  which  he 
calls  a  fucker,  aifec^ed  the  fyftem  nearly  in  the  fame 

*  Account  of  the  yellow  fever,  in  1793. 
f  Epidemics,  book  Iv, 

manner 


158  ON    THE    PROXIMATE 

manner  as  the  contagion  of  the  yellow  fever.  A 
diilrelTnig  vomiting,  a  coldnefs  of  the  extremities, 
and  an  abfence  of  pulfe,  were  fome  of  the  fyraptoms 
produced  by  it,  and  an  inflammation  and  mortifi- 
cation of  the  flomach  and  bowels,  were  difcovered 
after  death  to  be  the  effe6i:s  of  its  violent  operation. 

Even  opium  in  large  dofes,  fometimes  produces 
by  its  powerful  flimulus  the  fame  fymptoms  which 
are  produced  by  the  flimulus  of  what  are  called 
putrid  contagions.  Thefe  fymptom^s  are,  a  How 
pulfe,  coma,  a  vomiting,  cold  fweats,  a  fallow  colour 
of  the  face,  and  a  fupprelFion  of  the  difcharges  by 
the  urinary  pafTages  and  bowels. 

Error  is  often  perpetuated  by  words.  A  belief 
in  the  putrefa£i:ion  of  the  blood  has  done  great  mif- 
chief  in  medicine.  The  evil  is  kept  up,  under  the  in- 
fluence of  new  theories,  by  the  epithet  putrid,  which 
is  flill  applied  to  fever  in  all  our  medical  books. 
For  which  reafon  I  fhall  rejeft  it  altogether  hereafter, 
and  fubilitute  in  its  room 

2.  The  GANGRENOUS  ftate  of  fever,  for  what 
appear  to  fome  phyficians  to  be  figns  of  putrefadlion, 
are  nothing  but  the  ifTue  of  a  violent  inflammation 
left  in  the  hands  of  nature,  or  accelerated  by  flimu- 
lating  medicines.     Thus  the  fun,  when  viewed  at 

mid-day 


CAUSE    OF    FEVERr  I59 

mid-day/  appears  to  the  naked  eye,  from  the  excefs 
of  its  fplendor,  to  be  a  mafs  of  darknefs,  inftead  of 
an  orb  of  hght. 

The  fame  explanation  of  what  are  called  putrid 
fymptoms  in  fever,  is  very  happily  delivered  by  Mr. 
Hunter  in  the  follov^ing  words  :  "  It  is  to  be  ob- 
ferved  (fays  this  acute  phyfiologift)  that  when  the 
attack  upon  thefe  organs,  which  are  principally 
connected  with  life,  proves  fatal,  that  the  eiTe(fi:s  of 
the  inflammation  upon  the  conflitution,  run  through 
all  the  flages  with  more  rapidity  than  when  it  hap- 
pens in  other  parts  ;  fo  that  at  its  very  beginning, 
it  has  the  fame  effedl:  upon  the  conflitution,  which 
is  only  produced  by  the  fecond  itage  of  inflamma- 
tion in  other  parts."  * 

3.  The  SYNOCHA,  or  the  common  inflammatory 
flate  of  fever,  attacks  fuddenly  with  chills,  and  is 
fucceeded  by  a  quick,  frequent,  and  tenfe  pulfe, 
great  heat,  thirft,  and  pains  in  the  bones,  joints, 
breail,  or  fides.  Thefe  fymptoms  fometimes  occur 
in  the  plague,  the  jail  and  yellow  fever,  and  the 
fmall-pox  ;  but  they  are  the  more  common  charac- 
teriflics  of  pleurify,  gout,  and  rheumatifm.  They 
now  and  then  occur  in  the  influenza,  the  meafles, 
and  the  puerperile  fever. 

*  Treatife  on  Inflammation,  chap.  I.  8, 

A,  The 


l6o  ON    THE    PROXIMATE 

4.  The  BILIOUS  ftate  of  fever  is  produced  by 
marfli  miafmata  or  contagion,  ailing  fpecifically 
upon  the  biliary  du6ts,  or  it  may  be  induced  by  the 
ufual  remote  caufes  of  the  gout.  It  is  known  by 
a  full,  quick,  and  tenfe  pulfe,  or  by  a  quick,  full, 
and  round   pulfe,   without  tenfion,  and  by  a  dif- 

[  charge  of  green,  dark  coloured,  or  black  bile  from 
the  flomach  and  bowels. 

Befides  thefe  occafional  forms  of  bilious  fever,  it 
fometimes  puts  on  the  fymptoms  of  a  heflic.  I 
have  feen  many  inftances  of  it  in  the  autumn.  The 
patient  feels  no  pain  in  his  head,  has  a  tolerable 
appetite,  and  is  able  to  fit  up,  and  even  to  do  bu- 
fmefs.  My  late  invaluable  friend  Dr.  Clarkfon, 
died  of  this  flate  of  bilious  fever. 

5.  The  TYPHUS  flate  of  fever  is  generally  pre-r 
ceded  by  all  thofe  circumjflances  which  induce  direct 
debility.  It  is  known  by  a  weak  and  frequent 
pulfe,  a  difpofition  to  fleep,  a  torpor  of  the  alimen- 
tary canal,  tremors  of  the  hands,  a  dry  tongue,  and, 
in  fome  inftances,  by  a  diarrhcea.  Thefe  fymp- 
toms occur  moft  frequently  in  the  mild  grades  of 
the  jail  fever,  and  in  the  clofe  of  all  the  inflamma- 
tory ftates  of  fevers  in  which  depleting  remedies 
have  not  been  ufed  in  their  iirft  ftage.  I  heard 
of  it  in  a  few  cafes  in  the  yellow  fever  o(  17939 

4  and 


CAUSE    Ol?    ^EVER*  l^^f 

arid  all  writers  take  notice  of  cafes  of  the  plague, 
which  run  on  into  a  flow  fever  that  continues  10 
and  40  days.  1  have  feen  it  fucceed  the  common 
bilious  fever,  pleurify,  atld  influenza.  It  has  been 
confounded  with  the  malignant  ftate  of  fever,  undei- 
the  name  of  typhus  gravior ;  but  it  diiFers  widely 
from  it  in  being  accompanied  by  a  feeble  excitement 
in  the  blood-veffels,  from  a  feeble  ftimulus,  and  by 
the  ufual  figns  of  dire6l  debility  in  every  other  part 
of  the  body. 

From  the  acceflion  of  new  flimuli,  or  an  increafe 
in  the  force  of  former  ones,  this  typhus  ftate  of 
fever  fometimes  affumes,  on  the  nth,  14th,  and 
even  20th  days,  the  fymptoms  of  the  fynocha  ftate 
of  fever.  It  will  be  ufeful  to  remember  this  ob- 
fervation,  not  only  becaufe  it  eftablifties  the  unity 
of  fever,  but  becaufe  it  will  juftify  the  ufe  of  a 
remedy,  feldom  prefcribed  after  the  difeafe  haa 
acquired  that  name  which  aftbciates  it  with  ftimu- 
lating  medicines. 

The  common  name  of  this  ftate  of  fever  is,  the 
nervous  fever.  This  name  is  improper ;  for  it  in- 
vades the  nervous  fyftem  by  pain,  delirium,  and 
convuliions  much  lefs  than  feveral  other  ftates  of 
fever.  To  prevent  the  abfurd,  and  often  fatal  aiTo- 
f  iation  of  ideas  upon  the  treatment  of  this  ftate  of 

L  fever. 


tS2  ON    THE    PROXIMATE, 

fever,  I  fliall  hereafter  call  it,  from  its  duration,  the 
low  chronic  ftate  of  fever.     I  have  adopted  the  term 
l6w^  from  Dr.  Butter's  account  of  the  remitting 
fever  of   children,  in  order  to  diflinguilh  it  from 
flates  of  fever  to  be  mentioned  hereafter,  in  vrhich 
the  patient  is  not  confined  to  his  bed.     This  new 
name  of  the  typhus  or  nervous  fever,  eftablillies  its 
analogy  with  feveral  other  difeafes.     We  have  the 
acute  and  the  chronic  rheum.atifm ;  the  acute  and 
chronic  pneumony,   commonly   called   the  pleurify 
and  pulmonary  confumption  ;  the  acute  and  chronic 
inflammation  of  the  brain,  known  unfortunately  by 
the  unrelated  names  of  phrenitis,  madnefs,  and  in- 
ternal dropfy  of  the  brain.     Why  ihould  we  hefi- 
tate,  in  like  manner,  in  admitting  acute  and  chro» 
nic  fever  in  all  thofe  cafes  where  no  local  inflamma- 
tion attends. 

6.  The  typhoid  ftate  of  fever  is  compofed  of  the 
fynocha  and  low  chronic  ftates  of  fever.  It  is  the 
JIow  nervous  fever  of  Dr.  Butter.  The  excitement 
of  the  blood-veflfels  is  fomewhat  greater  than  in  the 
low  chronic  ftate  of  fever.  Perhaps  the  mufcular 
fibres  of  the  blood-veflels,  in  this  ftate  of  fever,  are 
affected  by  different  degrees  of  ftimulus  and  excite- 
ment. Suppofmg  a  pulfe  to  confift  of  eight  cords, 
I  think  I  have  frequently  felt  more  or  lefs  of  them 
tenfe  or  relaxed,  according  as  the  fever  partook 

more 


CAUSE    OF    FEVER*  fC^ 

more  or  lefs  of  the  fynocha,  or  low  chronic  flates 
of  fever.  This  flate  of  fever  occurs  moft  frequently 
in  what  are  called  the  hectic  and  puerperal  fevers, 
and  in  the  fcarlatina* 

Both  the  low  chronic,  and  the  typhoid  ftates  of 
fever  (the  fever  generated  in  jails,  Ihips,  and  hofpi- 
tals  excepted)  are  mod  frequently  artificial  difeafes. 
They  are  created  by  the  negligence  of  patients,  in 
not  fending  for  early  medical  aid,  or  by  the  ignorance 
of  phyficians  in  not  ufing  fufficient  evacuations. 

7.  There  is  a  ftate  of  fever  inclining  more  to  the 
fy nocha  than  what  is  called  the  typhus,  or  low 
chronic  flate  of  fever.  I  have  called  it  the  fjriQ^ 
choid  flate  of  fever. 

8.  There  is  a  flate  of  fever  in  which  the  pulfe  is 
fmall,  but  tenfe  and  quick*  The  patient,  in  this 
flate  of  fever,  is  feldom  confined  to  his  bed.  We 
obferve  it  fometimes  in  the  chronic  rheumatifm,  and 
in  pulmonary  confumption.  The  inflammatory  flate 
of  this  grade  of  fever  is  proved  from  the  inefficacy 
of  the  volatile  tin6lure  of  guaiacum  and  other  flimu- 
lants  to  remove  it,  and  from  its  yielding  fo  fuddenly 
to  blood-letting.  I  have  called  it  x\i^  fynochula  ilate 
of  fever. 

L  2  Q.  The 


i64  ON    THE    TROXIMATE 

9.  The  HECTIC  ftate  of  fever  differs  from  all  the 
other  flates  of  fever,  by  the  vi^ant  of  regularity  in 
its  paroxyfms,  in  vi^hich  chills,  fever,  and  fweats  are 
included  ;  and  by  the  brain,  nerves,  mufcles,  and 
alimentary  canal,  being  but  little  impaired  in  their 
fundions  by  it.  It  appears  to'  be  an  excluiive  dif- 
eafe  of  the  blood-veffels.  It  occurs  in  the  pulmo-^ 
riary  confumption,  in  fome  cafes  of  lues,  of  fcro- 
|)hula,  and  of  the  gout,  and  after  moil  of  the  flates 
t>f  fever  v^hich  have  been  defcribed.  The  force  of 
the  pulfe  is  various,  being  occafionally  fynochoid^ 
typhoid,  and  typhus. 

10.  There  is  a  ftate  of  fever  in  which  the  mor- 
bid action  of  the  blood-veffels  is  fo  feeble,  as  fcarcely 
to  be  perceptible.  Like  the  he£lic  ftate  of  fever,  it 
feldom  affe^ls  the  brain,  nerves,  mufcles,  or  alimen- 
tary canal.  It  is  knov^^n  in  the  fouthern  ftates  of 
America,  by  the  name  of  inward  fevers.  The 
Englifli  phyficians  formerly  defcribed  it  by  the  name 
of  febricula. 

11.  Intermiffions,  or  the  n^TERMiTTiNG  and  re- 
mitting ftates  of  fever,  are  common  to  all  the  ftates 
of  fever  which  have  been  mentioned.  But  they  oc- 
cur moft  diftinclly  and  univerfally  in  thofe  which 
partake  of  the  bilious  diathefis.  They  have  been 
afcribed  to  the  reproduclion  of  tlie  ftimulus  of  bile. 


CAUSE    OF    FEVER,  1 65 

to  the  recurrence  of  debility,  and  to  the  iniluence 
of  the  heavenly  bodies  upon  the  fyflem.  None  of 
thefe  hypothefes  has  explained  the  recurrence  of 
fever,  where  the  bile  has  not  been  in  fault,  where 
(Jebility  is  uniform,  and  where  the  paroxyfms  of 
fever  do  not  accord  with  the  revolutions  of  any 
part  of  the  folar  fyftem.  I  have  endeavoured  to 
account  for  the  recurrence  of  the  paroxyfm  of  fe- 
ver, in  common  with  all  other  periodical  difeafes, 
by  means  of  a  natural  or  adventitious  ajTociation 
of  motions.  Dr.  Percival  has  glanced  at  this  law 
of  animal  matter ;  and  Dr.  Darwin  has  explained 
by  it,  in  the  rnoft  ingenious  manner,  many  natural 
and  morbid  a6lions  in  the  human  body. 

12.  The  SWEATING  ftate  of  fever  occurs  in  the 
plague,  in  the  yellow  fever,  in  the  fmall-pox,  the 
pleurify,  the  rheumatifm,  and  in  the  hectic  and  in- 
termitting ftates  of  fever.  Profufe  fweats  appeared 
every  other  day  in  the  autumnal  fever  of  1795  in 
Philadelphia,  without  any  other  fymptom  of  an  in- 
intermittent.  The  Englifli  fweating  ficknefs  was 
nothing  but  a  fymptom  of  the  plague.  The  fweats 
in  all  thefe  cafes  are  the  effects  of  morbid  and  ex- 
ceiTive  action,  concentrated  in  the  capillary  veiTels. 

13.  The  FAINTING  ftate  of  fever  accompanies 
the  plague,  the  yellow  fever,  the  fmall-pox,    and 

L  3  fome 


1 66  ON    THE    PROXIMATE 

fome  dates  of  pleiirify.  It  is  the  efte£l  of  great 
indirefl  debility ;  hence  it  occurs  mod  frequently 
in  the  beginning  of  thofe  dates  of  fever. 

14.  The  BURNING  date  of  fever  has  given  rife  to 
what  has  been  called  a  fpecies  of  fever.  It  is  the 
caufus  of  authors.  Dr.  Mofely,  who  rejects  the 
epithet  of  yellow,  when  applied  to  the  bilious 
fever,  becaufe  it  is  only  one  of  its  accidental 
fymptoms,  very  improperly  didinguidies  the  fame 
fever  by  another  fymptorn,  viz.  the  burning  heat 
of  the  iliin,  and  which  is  not  more  univerfal  than 
the  yelipwnefs  v/hicji  attends  it, 

15.  The  COLD  and  chilly  date  of  fever  differs 
from  a  common  chilly  fit,  by  continuing  four  or 
five  days,  and  to  fuch  a  degree,  that  the  patient 
frequently  cannot  bear  his  arms  out  of  the  bed. 
The  coldnefs  is  mod  obdinate  in  the  hands  and  feet. 
A  COOLNESS  only  of  the  ddn  attends  in  fome  cafes, 
which  is  frequently  midaken  for  an  abfence  of  fe- 
ver. 

Having  mentioned  thofe  dates  of  fever  which 
affect  the  arterial  fydem,  without  any,  or  with 
but  little  topical  afrecl:ion,  I  proceed  next  to  enu- 
merate thofe  dates  of  fever  in  which  there  are 
local  affections  combined  more  or  lefs  with  general 

,     fever, 


•     CAUSE    OF    FEVER.  ^  157 

fever.  They  depend,  i.  Upon  local  debility  in 
the  part  afFe6i:ed.  2.  Upon  increafed  excitability  in 
the  part,  in  conlequence  of  this  debility.  And,  3. 
Upon  the  morbid  excitement  induced  in  the  part, 
by  the  flimulus  of  diftention  from  the  blood,  and 
by  the  efFulion  of  ferum,  lymph,  or  red  globules  in. 
the  weakened,  and  afterwards  inflamed  part.  The 
reader  will  perceive  here  that  I  adopt  the  error  loci 
of  Dr.  Boerhaave,  as  a  link  in  the  chain  of  caufes 
which  produce  local  inflammation.  The  ftates  of 
fever  which  belong  to  this  fecond  head  are  as  follow. 

16.  The  INTESTINAL  ftatc  of  fever.  I  have 
been  anticipated  in  giving  this  epithet  to  fever,  by 
Dr.  Balfour.  *  It  includes  the  colera  morbus,  diar-* 
rhoea,  dyfentery,  and  colic.  The  remitting  bilious 
fever  appears,  in  all  the  above  forms,  in  the  fummer 
months.  They  all  belong  to  the  febris  introverfa 
of  Dr.  Sydenham.  The  jail  fever  appears  likewife 
frequently  in  the  form  of  diarrhoea  and  dyfentery. 
The  dyfentery  is  the  olTspring  of  miafmata  and  con- 
tagion, but  it  is  often  induced  in  a  weak  flate  of 
the  bowels,  by  other  exciting  caufes.  The  colic 
occafionally  occurs  with  itates  of  fever  to  be  men- 
tioned hereafter. 

*  Account  of  the  Inteftinal  Remitting  Fever  of  Bengal. 
V  L4  17.  The 


l6S  ON    TH^    PROXIMATE 

17,  The  PULMONARY  flate  of  fcver  includes  the 
tvic  and  bailard  pneumony  in  their  acute  forms ; 
gjfo  catarrh  from  cold  and  contagion,  and  the  chro^ 
jiic  form  of  pneumony  in  what  is  called  pulnionary 
eonfumption* 

T 

18,  The  ANGIN031E:  ftat^  of  f&ver  includes  all 
thofe  affedions  of  the  throat  which  are  known  by  the 
names  of  cynanche,  inflammatoria,  tonfiUaris,  paro- 
tidea,  maligna,  fcarlatina,  and  trachealis.  The  cy- 
nanche  trachealis  is  a  febrile  difeafe.  The  mem« 
brane  which  produces  fufFocation  and  death  in  the 
wind-pipe,  is  the  efFe£i:  of  inflammation.  It  is  pro- 
bably formed,  like  other  niembranes  which  fuc« 
ceed  inflammation,  from  the  coagulable  lymph  of 
the  bloodo 

19,  The  RHEUMATIC  Hate  of  fever  is  confined 
chiefly  to  the  labouring  part  of  mankind.  The 
topical  afle£i:ion  is  feated  moll  commonly  in  the 
joints  and  mufcles,  which  from  being  exercifed 
more  than  other  parts  of  the  body,  become  mor§ 
debilitated,  and  are,  in  confequence  thereof,  ex* 
cited  into  morbid  or  inflammatory  a^ion. 

20,  The  ARTHRITIC  or  GOUTY  flate  of  fever, 
differs  from  the  rheumatic,  in  aifefting,  with  the 
joints  and  mufcies,  all  the  nervous  and  lymphatic 

fyflierasj 


CAUSE    OF    FEVER.  169 

fyftems,  the  vlfcera,  and  the  ilvin  ;  alfo  In  having 
a  fpeclfic  remote  caufe,  viz.  intemperance.  Its 
predifpofmg,  exciting,  and  proximate  caufes  are  the 
fame  as  the  rheumatic  and  other  dates  of  fever. 
It  bears  the  fame  ratio  to  rheumatifm,  which  the 
yellow  fever  iDears  to  the  common  bilious  fever. 
It  is  a  fever  of  mgre  force  than  rheumatifmo 

21.  The  MANIACAL  {late  of  fever.  I  prov£ 
mania  to  be  a  fever^  i.  From  its  caufes,  which 
are  the  fame  as  thofe  which  induce  all  the  other 
dates  of  fever.  2.  From  its  fymptoms,  particu- 
larly 21  full,  tenfe,  quick,  and  fometimes  a  flov/ 
pulfe.  3.  From  the  inflammatory  appearances  of 
the  blood  which  has  been  drawn  to  relieve  it. 
And,  4.  From  the  phenomena  exhibited  by  diffec- 
tion  in  the  brains  of  maniacs,  being  the  fame  as  are 
exhibited  by  other  inflamed  vifcera  after  death. 
Thefe  are,  effulions  of  water  or  blood,  abfceffeSj 
and  fchirrus.  The  hardnefs  in  the  brains  of  ma- 
niacs, taken  notice  of  by  feveral  authors,  is  no- 
thing but  a  fchirrus  (fui  generis)  induced  by  the 
negle£l  of  fufHcient  evacuations  in  this  flate  of  fever. 
The  reader  will  perceive  by  thefe  obfervations, 
that  I  reje^l:  madnefs  from  its  fuppofed  primary 
feat  in  the  mind  or  nerves.  It  is  as  much  an  ori*. 
ginal  difeafe  of  the  blood-veflels,  as  any  other  flate 
©f  fever.     It  is  t^)  phrenitis,  what  pulmonary  con- 

fumption 


170  ON    THE    PROXIMATE 

fumption  is  to  pneumony.  The  derangement' iii 
the  operations  of  the  mind  is  the  c&£i  only  of 
a  chronic  inflammation  of  the  brain,  exilline  with^ 
out  an  abflradlion  of  mufcular  excitement. 

22.  The  APOPLECTIC,  23.  the  phrenitic, 
24.  the  paralytic,  25.  the  lethargic,  and  26. 
the  VERTIGINOUS  flatcs  of  fever,  often  accom- 
pany the  malignant  fliate  of  fever.  They  are  com- 
monly the  eiFe(5i:s  of  flrong  flimuli  afting  fuddenly 
upon  the  brain  in  the  beginning  of  fever  ;  but  they 
fometimes  occur  in  the  clofe  of  the  comm.on  ftates 
of  fever,  m.ore  efpecially  where  blood-letting  has 
not  been  ufed  in  a  fiifficient  quantity. 

27.  The  HYDROCEPHALIC  flate  of  fever  occurs 
chiefly  in  children.  The  water  which  is  found  in 
the  brain,  is  the  effect  of  inflammation.  To  the 
proofs  from  dilTedions  which  I  publifhed  formerly,* 
of  the  inflammatory  nature  of  this  flate  of  fever,  I 
fliall  add  one  more,  communicated  to  m^e  by  my  for- 
mer pupil  Dr.  Coxe,  in  a  letter  from  London,  dated 
July  17th,  1795.  "  It  fo  happened  (fays  my  inge- 
nious correfpondent)  that  at  the  time  of  my  receiv- 
ing your  letter.  Dr.  Clark  was  at  the  hofpital.  I 
read  to  him  that  part  of  it  which  relates  to  your 
fuccefs  in  the  treatment  of  hydrocephalus  internus. 

*  Medical  Inquiries  and  Obfervations,  Vol.  II. 

He 


CAUSE    OF    FEVER.  I7I 

He  was  mncli  pleafed  with  It,  and  mentioned  to  me 
a  fci£t,  which  flrongly  corroborates  your  idea  of  its 
being  a  primary  inflammation  of  the  brain.  This 
fa£l  was,  that  upon  opening,  not  long  fmce,  the  head 
of  a  child  who  had  died  of  this  difeafe,  he  found 
between  three  and  four  ounces  of  water  in  the  ven- 
tricles of  the  brain ;  alfo  an  inflammatory  crufl  on 
the  optic  nerves,  as  thick  as  he  had  ever  obferved  it 
on  the  intefl:ines  in  a  ilate  of  inflammation.  The 
child  lofl:  its  fight  before  it  died.  The  crufl:  account- 
ed, in  a  fatisfadlory  manner,  for  its  biindncfs.  Per- 
haps fomething  flmilar  may  be  always  noticed  in  the 
diile^lions  of  fuch  as  die  of  this  difeafe,  in  whom 
the  eyes  are  much  affciSLed." 

30.  The  NEPHRITIC  ftate  of  fever  is  often  In- 
duced by  calculi,  but  it  frequently  occurs  in  the 
gout,  fmall-pox,  and  malignant  ftates  of  fever.  There 
is  fuch  an  engorgement,  or  choaking  of  the  veflTels 
of  the  kidneys,  that  the  fecretion  of  the  urine  is 
fometiraes  totally  obflrufed,  fo  that  the  bladder 
yields  no  water  to  the  catheter.  It  is  generally  ac- 
companied with  a  full  or  tenfe  pulfe,  great  pain, 
ficknefs,  or  vomiting,  high  coloured  urine,  and  a 
pain  along  the  thigh  and  leg,  v/ith  occafionally  a 
retra6bion  of  one  of  the  teftlcles.  It  exifl:s  fome- 
times  without  any  pain.  Of  this  I  met  with  feveral 
iuftances  in  the  yellow  fever  of  1 793. 

-^i.  The 


172  ON    THE    PROXIMATE 

3 1.  The  DROPSY,  whether  local  or  general  is  a 
fiaic  of  fever.  There  are  feveral  flates  of  fever 
which  are  more  frequently  accompanied  by  ferous 
eftufions  than  others.  Thefe  are  the  fcarlet,  the 
puerperal,  and  the  rheumatic  dates  of  fever.  They 
all  difpofe  to  effufions  in  the  limbs,  Intermittents 
tend  to  produce  thofe  conjeflions  in  the  abdominal 
vifcera  which  terminate  in  effufions  in  the  belly,  A 
negle^ied  catarrh,  and  a  half  cured  pneumony,  tend 
to  produce  effufions  in  the  thorax^  while  a  chronic 
phrenitis  relieves  itfelf  by  an  effulion  of  water  in  the 
brain.  Nineteen  dropiies,  out  of  twenty  appear  to 
be  original  arterial  difeafes ;  and  the  water,  which 
has  been  fuppcfed  to  be  the  caufe  of  the  dropfy,  is  as 
much  the  effeel  of  preternatural  and  morbid  a6i:ion 
in  the  blood-velTels,  as  pus,  gangrene,  and  fchirrus 
are  of  previous  inflammation.  The  common  febrile 
fymptoms  which  accompany  dropfy,  render  this 
highly  probable  ;  but  it  has  lately  been  demon- 
ftrated  by  diffe^tion,  by  Mr.  Samuel  Cooper,  the 
apothecary  of  the  Pennfylvania  hofpital,  in  a  man 
who  died  of  an  afcites.  Pus  and  blood,  as  well  as 
water,  were  found  in  the  cavity  of  the  abdomen.* 

*  The  origin  of  dropfy,  in  the  negle^fl  of  blood-letting  in 
fevers,  has  been  afcertalncd  by  many  obfervations  j  hence 
that  difeafe  occurs  rnoft  frequently  where  bleeding  is  feldom 
ufed.  Dr.  Wilkes  mentions  a  fa(5l  which  is  diredly  to  cur 
purpofe.     <<  After  the  laft  epidemical  fever  (fays  the  Do<5lor), 

It 


CAUSE    OF    FEVER.  I7J 

It  is  no  obje(^ion  to  this  theory  of  dropfy,  that 
we  fometimes  find  water  in  the  cavities  of  the  body 
after  death,  without  any  marks  of  inflammation  on 
the  contiguous  blood- velTels.  We  often  find  pus 
both  in  the  living  and  dead  body  under  the  fame 
circumflances,  wdiere  wie  are  fure  it  was  preceded 
by  inflammation. 

33.  The  ERUPTIVE  ftate  of  fever  includes  the 
fmall-pox,  meafles,  and  all  the  other  exanthemata  of 
Dr.  Cullen. 

33.  The  HEMORRHAGIC  ftatc  of  fever  Is  always 
the  effect:  of  preternatural  excitement  in  the  blood- 
veffels.  Hcemorrhages  have  been  divided  into  a£live 
and  paffive.  It  would  be  more  proper  to  divide 
them,  like  other  ftates  of  general  fever,  into  haemor- 
rhages of  flrong  and  feeble  morbid  aflion.  There 
is  feldom  an  ilTue  of  blood  from  a  veffel  in  which 
there  does  not  exifl  preternatural  or  accumulated 
excitement.  We  obferve  this  haemorrhagic  flate  of 
fever  moil  frequently  in  malignant  fevers,  in  pul- 
monary confumption,  in  pregnancy,  and  in  that 
period  of  life  in  which  the  menfes  ceafe  to  be  regular, 

which  began  at  Kldderminfter  in  1728,  and  foon  after  fpread, 
not  only  over  Great  Britain,  but  all  Europe,  more  people 
died  dropfical  in  three  years,  than  did  perhaps  in  20,  or  30 
years  before,'* 

Hiftorical  EiTay  on  the  dropfy,  p.  326. 

33.  The 


174  Oyi    THE    PROXIMATE 

34.  The  AMENORRHAGic  flatc  of  fever  occurs 
more  frequently  than  is  fufpefled  by  phyficians, 
A  full  and  quick  pulfe,  thirft,  and  preternatural 
heat,  often  accompany  a  chronic  obflru61:ion  of  the 
menfes.  The  inefficacy  and  even  hurtful  effedls, 
of  what  are  called  emenagogue  medicines,  in  this 
ilateofthe  fyflem,  without  previous  depletion,  fhew 
the  propriety  of  introducing  it  among  the  different 
ffiates  of  fever. 

35.  The  haemorrhoids  are  frequently  a  local 
difeafe,  but  they  are  fometimes  accompanied  with 
pain,  giddinefs,  chills  and  an  aclive  pulfe.  When 
iliis  is  the  cafe,  I  have  given  them  the  name  of  the 
ji^MORRHoiDAL  ftatc  of  fcver. 

36.  The  opthalmia  when  it  occurs  with  the  fymp- 
toms  of  general  fever,  may  properly  be  confidered 
as  an  opti-ialmic  itate  of  fever. 

We  cam.e  now  in  the  third  and  lall  place  to  mention 
the  mifplaced  ilates  of  fever.  The  term  is  not  a 
new  one  in  medicine.  We  read  of  mifplaced  gout. 
Morbid  excitement,  in  feveral  other  ftates  of 
fever,  is  equally  liable  to  be  tranflated  from  the 
blood-velTels  to  other  parts  of  the  fyflem.  The 
periodical  pains  in  the  head,  eyes,  ears,  jaws,  hips 
s.]id  back,  which    occur    in    the   fckly    autumnal 

months. 


CAUSE    OF    FEVER,  I^J 

months,  and  which  impart  no  fulnefs,  force,  or  fre- 
quency to  the  pulfe,  are  all  mifplaced  fevers.  But 
there  are  other  morbid  affections  which  are  lefs 
fufpe6led  of  belonging  to  febrile  diforders.  Thefe 
are, 

37.  The  HEPATIC  ftate  of  fever.  The  caufes, 
fymptoms,  and  remedies  of  the  liver  diforder  of  the 
Eaft  Indies,  as  mentioned  by  Dr.  Gravenftine,  all 
prove  that  it  is  nothing  but  a  bilious  fever  tranllated 
from  the  blood- veiTels,  and  abforbed,  or  fuffocated 
as  it  were  in  the  liver.  This  view  of  the  chronic 
hepatitis  is  important,  inafmuch  as  it  leads  to  the 
liberal  ufe  of  all  the  remedies  which  cure  bilious 
fever.  Gall  ftones  and  contulions,  now  and  then 
produce  a  hepatitis,  but  under  no  other  circum- 
ftances  do  I  believe  it  ever  exifts,  but  as  a  fymptom 
of  general,  or  latent  fever. 

38.  The  CONVULSIVE  or  fpafniodlc  ftate  of  fever, 
Convulfions  it  is  well  known  often  uflier  in  fevers, 
more  efpecially  in  children.  But  the  conne£l:ion 
between  fpafmodic  affections,  and  fever  in  adults 
has  been  lefs  attended  to  by  phyficians.  The  fame 
caufes  which  produced  general  fever  q.nd  hepatitis 
in  the  Eaft  Indies,  in  fome  foldiers,  produced  locked 
jaw  in  others.  Several  of  the  fymptoms  of  this  difor- 
der as  defcribed  by  Dr.  Girdleftone,  fuch  as  coldnefs 

oa 


17^  ON    THE    PROXIMATE 

on  the  furface  of  the  body,  cold  fweats  on  the  iiands 
and  feet,  intenfe  third,  a  white  tongue,  inceffant 
vomitings,  and  carbuncles,  all  belong  to  the  malig- 
nant Hate  of  fever,*  By  means  of  blood-letting, 
and  the  other  remedies  for  the  violent  flate  of  bilious 
fever,  I  have  feen  the  convulfions  in  this  diforder, 
tranilated  from  the  mufcles  to  the  blood-velfelsj 
where  they  immediately  produced  all  the  common 
fymptoms  of  fever. 

39^    TheiiYSTERICAL  and  KYPOCHONiDRlACAL 

itates  of  fever.  The  former  is  known  by  a  rifmg 
in  the  throat,  which  is  for  the  mofl  part  erroneoufly 
afcribed  to  worms,  by  pale  urine,  and  by  a  difpofi- 
tion  to  flied  tears,  or  to  laugh  upon  trifling  oc- 
cafions.  The  latter  difcovers  itfelf  by  falfe  opinions 
of  the  nature  and  danger  of  the  difeafe  under  which 
the  patient  labours.  Both  thefe  llates  of  the  ner- 
vous fyftem  occur  frequently  in  the  gout  and  in  the 
malignant  ftate  of  fever.  It  is  common  to  fay. 
In  fuch  cafes,  that  patients  have  a  complication  of 
clifeafes;  but  this  is  not  true,  for  the  hyfterical  and 
hypochondrical  fymptoms  are  nothing  but  the  effe^ls 
of  one  remote  caufe,  concentrating  its  force  chiefly 
upon  the  nenres,  and  mufcle?.  It  was  in  this  ftate 
of  fever  that  patients  fat  up,  walked  about  their 

*  Elfay  on  the  Spafmodlc  AfFedlons  in  India,  p.  $1-  54-  SS- 

I  rooms, 


CAU^E    OF    FEVER.  I77 

i'Ooms,  and  even  went  out  into  the  ftrcets  a  few 
hours  before  they  died,  in  the  epidemic  of  1793  in 
Philadelphia. 

40.  The  CUTANEOUS  ftate  of  fever.  Dr.  Sy* 
denham  calls  a  dyfentery  a  "  febris  introverfa." 
Eruptions  of  the  ikin  are  often  nothing  but  the 
reverfe  of  this  introverted  fever.  They  are  a  fever 
tranflated  to  the  ikin  ;  hence  we  find  them  mofl  com^- 
mon  in  thofe  countries  and  feafons  in  which  fevers 
are  epidemic.  The  prickly  heat,  the  rafli,  and  the 
effere  of  authors,  are  all  Hates  of  mifplaced  fever> 
"  Agues,  fevers,  and  even  pkurifia  (fays  Mr. 
Townfend  in  his  journey  through  Spain  *)  are  faid 
often  to  terminate  in  fcabies,  and  this  frequently 
gives  place  to  them,  returning  however  when  the 
fever  ceafes.  In  adults  it  takes  poil'elTion  of  the 
hands  and  arms,  with  the  legs  and  thighs,  covering 
them  with  a  filthy  crufl."  Small  boils  are  common 
among  the  children  in  Philadelphia,  at  the  time 
the  colera  infantum  makes  its  appearance.  Thefe 
children  always  efcape  the  fummer  epidemic.  The 
elephantiafis  defcribed  by  Dr.  Hillary  in  his  account 
of  the  difeafes  of  Barbadoes,  is  evidently  a  tranfla- 
tion  of  an  intermittent  to  one  of  the  limbs.  It  is 
remarkable  that  the  leprofy  and  malignant  fevers  of 

*  Vol.  IL  Dublin  edition,  p   262, 

M  all 


lyS  ON    THE    PROXIMATE 

all  kinds  have  appeared  and  declined  togetlier  in 
the  fame  ages  and  countries.  But  further,  petechias 
fometimes  appear  on  the  ikin  without  fever.  Cafes 
of  this  kind  with,  and  without  haemorrhages,  are 
taken  notice  of  by  Riverius,*  Dr.  Duncan,  and 
many  other  practical  writers.  They  are  cotempo- 
rary,  or  fubfequent  to  fevers  of  a  malignant  com- 
plexion. They  occur  likewife  in  the  fcurvy.  From 
fome  of  the  predifpofmg,  remote  and  exciting  caufes 
of  this  difeafe,  and  from  its  fymptoms  and  remedies, 
I  have  fufpefled  it,  like  the  petechice  mentioned  by 
Riverius,  to  be  originally  a  fever  generated .  by 
human  miafmata,  in  a  mifplaced  ftate.  The  haemor- 
rhages which  fometimes  accompany  the  fcurvy,  cer- 
tainly arife  from  a  morbid  flate  of  the  blood-veifels. 
The  heat,  and  quick  pulfe  of  fever,  are  probably 
abfent,  only  becaufe  the  preternatural  excitement 
of  the  whole  fanguiferous  fyflem  is  confined  to  thofe 
extreme  or  cutaneous  vefTels  which  pour  forth 
blood.  In  like  manner  the  fever  of  the  fmall-pox 
deferts  the  blood-vefTels,  as  foon  as  a  new  a6lion 
begins  on  the  fkin.  Or  perhaps  the  excitability  of 
the  larger  blood-vefTels  may  be  fo  far  exhaufted  by 
the  long,  or  forcible  imprefiion  of  the  remote  and 
predifpofing  caufes  of  the  fcurvy,  as  to  be  incapable 
of  undergoing  the  convulfive  aflion  of  general  fever, 

"^  Praxis  Medica,  lib.  xviii.  cap.  i. 

With 


Cause  of  fever^  175 

With  this,  I  clofe  my  inquiry  into  the  proximate 
caufe  of  fever.  It  is  imperfeft  from  its  brevity,  as 
well  as  from  other  caufes.  I  commit  it  to  my  pupils 
to  be  corrected  and  improved. 

"  We  think  our  fathers  fools,  fo  wife  we  grow. 
"  Our  wifer  fons  I  hope  will  thiak  us  fo/* 


u  u 


DEFENCE 


OF  \^ 


BLOOD-LETTING 


AS    A 


REMEDY 


FOK 


CERTAIN  DISEASES. 


DEFENCE,  &c. 


XjEFORE  I  proceed  to  the  Defence  of 
Blood-letting  as  a  remedy  for  certain  difeafes,  par- 
ticularly for  fevers,  it  will  be  neceflary  to  introduce 
a  fyllabus  of  all  the  ufual  remedies  for  fever,  in  its 
ordinary  ftate.     They  conUll, 

I.  Of  fuch  things  as  leflen,  by  the  abflra^lion  of 
ftimulus,  the  morbid  and  exceffive  a6lion  of  the 
blood-veflels. 

II.  Of  fuch,  as  by  exciting  a6lion  in  the  flomach, 
bowels,  brain,  nerves,  mufcles,  and  ikin,  equalize 
the  excitement  of  the  whole  fyllem,  and  thereby  in- 
directly deftroy  a  weak  but  morbid  action  in  the 
blood-veflels,  by  imparting  to  them  a  more  vigo- 
rous and  healthy  a6lion. 

I.  The  remedies  which  belong  to  the  first  ge- 
neral head  are, 

M  4  I.  Eva- 


184  A    DEFENCE    OF    BLOOD-LETTING, 

I.  Evacuant;.     Thefe  are, 

1.  B'ood-letting. 

2.  Vomits. 

3.  Purges. 

4.  Sweating  medicines^ 

5.  A  falivation. 

6.  Blifters. 

II.  Remedies  which  abftraiTt  the  iTimulus 
*--  of  heat  by  i.  cold  air, 

3.  cold  water,  and, 
:  3.  ice. 

•«-  of  food  by  4.  abflinence. 

—  of  found  and  light  by        5.  iilence  and  darknefs* 

—  ofinvigoratingpalTionsby  6.  moderate  fear. 
i^w  of  motion  by  7.  reft. 

W49- of  acrimony  by  8.  diluting  drinks,  and, 

9.  cleanlinefs. 

m.  Remedies  which  divert  local  congeftion,  in- 
flammation, and  ferous  efFufion  from  vital  parts,  to 
fuch  as  are  lefs  effential  to  life.  Thefe  are  all  fuch 
as  are  mentioned  under  the  head  of  evacuants,  par. 
ttcularly  a  falivation  and  blifters. 

IV.  Medicines  faid  to  poffefs  fedative  powers, 
fuch  as 

I .  Nitre,  and  other  neutral  falts. 

2.  Certain 


A    DEFENCE    OF    BLOOB-I^ETTIKG.  1 85 

2-  Certain  preparations  of  antimony. 

3.  Sugar  of  lead* 

4.  Fox-glove. 

5.  Applications  of  fwcet  oil  to  the  CKtemal 
furface  of  the  body. 

II.  The  remedies  which  belong  to  the  sEt:oND 
general  head,  are  ftimulants.  Thefe  divide  them- 
felves  naturally  into  fuch  as  are  internal,  and  fuch 
as  are  external. 

I.  The  internal  Itimulants  may  further  be  divided 
into  medicines  and  aliments.     The  medicines  are 

1.  All  fermented  and  diililled  liquors. 

2.  Volatile  alkali. 

3.  Empyreumatic  and  aromatit:  oils. 

4.  Opium. 

5.  ^ther. 

'     6.  Bark,  and  bitters  of  all  kinds. 

7.  Mercury. 

8.  Pure  air. 

9.  The  invigoration    of  the  paflions  and  un- 
ftanding. 

The  aliments  include  fuch  vegetable  and  animal 
matters,  as  are  commonly  ufed  in  diet,  together 
with  fago,  faloop,  tapioca,  and  the  like. 

II.  The 


l86  A    DEFENCE    OF    BLOOD-LETTING. 

II.  The  external  ilimulants  are 

1.  Several  of  the  internal  flimulants  fo  pre- 
pared, as  to  be  applied  to  different  parts  of  the 
body,  as  the  nofe,  the  temples,  the  external  re- 
gions of  the  ftomach  and  bowels,  the  limbs,  and 
the  lower  inteflines,  by  way  of  glylfer. 

2.  The  cold  and  warm  baths. 

3.  Bliflers. 

4.  Cataplafms  of  onions,  garlic,  and  muflard, 
to  the  feet. 

5.  Canities. 

6.  Boiling  water* 

I  return  now,  agreeably  to  the  title  of  this  effay, 
to  confider  blood-letting  as  a  remxdy  for  fevers, 
and  certain  other  difeafes.  In  treating  of  the 
comparative  advantages  of  blood-letting,  I  fhall 
be  under  the  neceflity  of  making  a  few  remarks 
upon  each  of  the  remedies  fet  down  in  the  fyllabus, 
under  the  head  of  evacuants. 

I  fhall  begin  this  fubjeft  by  remarking,  that 
blood-letting  is  indicated  in  the  inflammatory  flate 
of  fever, 

I.  By  the  fudden  fuppreflion  or  diminution  of 
the  natural  difcharges  by  the  pores,  bowels,  and  kid- 
neys, whereby  a  plethora  is  induced  in  the  fyftem. 

2.  By 


A    DEFENCE    Of    BLOOD-LETTING.  187 

2.  By  the  robuft  habits  of  the  perfons  who  are 
moil  fubje(Si:  to  the  inflammatory  ftate  of  fever. 

3.  By  the  proximate  caufe  of  fever.  I  have  at- 
tempted to  prove  that  the  inflammatory  flate  of 
fever  depends  upon  morbid  and  exceiTive  aci:ion  in 
the  blood-vefTels.  It  is  connected,  of  courfe,  with 
preternatural  fenfibility  in  their  mufcular  fibres. 
The  blood  is  one  of  the  moil  powerful  flimuli  which 
a6i:  upon  them.  By  abllra^iing  a  part  of  it,  we 
leiTen  the  principal  caufe  of  the  fever.  The  effe^ 
of  blood-letting  is  as  immediate  and  natural  in  re- 
moving fever,  as  the  abftra^lion  of  a  particle  of  fand 
is  to  cure  an  inflammatiou  of  the  eye,  w^hen  it  arifes 
from  that  caufe. 

4.  By  the  fymptoms  of  the  firil  flage  of  this  ilatc 
of  fever,  fuch  as  a  ileepinefs  and  an  opprefTed  pulfe^ 
cr  by  delirium,  with  a  throbbing  pulfe  and  great 
pains,  in  every  part  of  the  body. 

5.  By  the  rupture  of  tlie  blood-vefTcls,  w^hich 
takes  place  from  the  quantity  or  impetus  of  the 
blood  in  inflammatory  fever.  Let  no  one  call  bleed- 
ing a  cruel  or  unnatural  remedy.  It  is  one  of  the 
fpecifics  of  nature ;  but  in  the  ufc  of  it  fhe  feldom 
affords  much  relief.  Siie  frequently  pours  the  flimu- 
Jating  and  oppreiTmg  mafs  of  blood  into  the  lungs 

and 


J  88  A    DEFENCE    OF    BLOOD-LETTING. 

and  brain;  and  when  flie  finds  an  outlet  for  it 
through  the  nofe,  it  is  difcharged  either  in  fuch  a 
deficient  or  exceiTive  quantity,  as  to  be  ufelefs  or 
hurtful.  By  artificial  blood-letting,  we  can  choofe 
the  time  and  place  of  drawing  blood,  and  we  may 
regulate  its  quantity  by  the  degrees  of  zQion  in  the 
blood-vefiels.  The  difpofition  of  nature  to  cure 
the  inflammatory  ilate  of  fever  by  depletion,  is  fur- 
ther manifefled  by  her  fubflituting,  in  the  room  of 
blood-letting,  large,  but  lefs  fafe  and  lefs  beneficial, 
evacuations  from  the  flomach  and  bowels. 

6.  By  the  relief  which  is  obtained  in  fevers  of 
violent  a£lion  by  remedies  of  lefs  efiicacy  (to  be 
mentioned  hereafter)  which  aft  indireftly  in  re- 
ducing the  force  of  the  fanguiferous  fyftem. 

7.  By  the  immenfe  advantages  which  have  at- 
tended the  ufe  of  blood-letting  in  the  inflammatory 
ilate  of  fever,  when  ufed  at  a  proper  time,  and  in  a 
quantity  fuited  to  the  force  of  the  difeafe.  I  fliall 
briefly  enumerate  thefe  advantages. 

3.  It  frequently  flirangles  a  fever  when  ufed  in 
its  forming  flate,  and  thereby  faves  much  pain,  time, 
and  expenfe  to  a  patient. 

2.  It  imparts  flrength  to  the  body,  by  removing 
the  preflure  of  indireft  debility.      It  moreover  ob- 
viates 


A    DEFENCE    OF    BLOOD-LETTING.  iS^ 

viates  a  difpofitiou  to  faint,  which  arifes  from  this 
ftate  of  the  fyflem. 

3,  It  reduces  the  uncommon  frequency  of  the 
pulfe.  The  lofs  of  ten  ounces  of  blood  reduced 
Mifs  Sally  Eyre's  pulfe  from  176  ftrokes  to  140 
in  a  few  minutes,  in  the  fever  of  the  year  1 794* 

4,  It  renders  the  pulfe  more  frequent  when  it 
is  preternaturally  flow. 

5,  It  checks  the  naufea  and  vomiting  which  at- 
tend the  malignant  flate  of  fever.  Of  this  I  faw 
many  inflances  in  the  year  1794.  Dr.  Poiffonnier 
Defperrieres  confirms  this  remark  in  his  Account  of 
the  Fevers  of  St.  Domingo  ;  and  adds  further,  that 
it  prevents,  when  fufficiently  copious,  the  trouble- 
fome  vomiting  which  often  occurs  on  the  fifth  daj 
of  the  yellow  fever.  * 

6,  It  renders  the  bowels,  when  coflive,  more 
eafily  moved  by  purging  phyfic. 

7,  It  renders  the  a61:ion  of  mercury  more  fpeedy 
and  more  certain  in  exciting  a  falivation* 

*  Traite  des  fi^vres  de  Vide  de  St.  Domingue.  Vol.  II. 
p.  76. 

8.  It 


19^  A    D^FE^CE    OF   ELOOr)-LETTlNd* 

8.  It  difpofes  the  body  to  fweat  fpontaneoull}% 
or  renders  diluting  and  diaphoretic  medicines  more 
effedlual  for  that  purpofe. 

9-  It  fuddenly  removes  a  drynefs,  and  gradually 
a  blacknefs,  from  the  tongue.  Of  the  former  ef- 
fect of  bleeding,  I  faw  two  inflances,  and  of  the  lat- 
ter, one,  during  the  autumn  of  1794* 

10.  It  removes  or  leiTens  pain  in  every  part  of 
the  body,  and  more  efpecially  in  the  head, 

1 1.  It  removes  or  leffens  the  burning  heat  of  the 
fkin,  and  the  burning  heat  in  the  flomach,  fo  com- 
mon and  fo  diilreffing  in  the  yellow  fever. 

12.  It  removes  a  conflant  chillinefs  which  fome« 
times  continues  for  feveral  days,  and  which  will 
neither  yield  to  cordial  drinks,  nor  warm  bed-cloaths. 

13.  It  checks  fuch  fweats  as  are  profufe  \Vith- 
out  affording  relief,  and  renders  fuch  as  are  partial 
and  moderate,  univerfal  and  falutary. 

14.  It  fometimes  checks  a  diarrhoea  and  tenefmus, 
after  aflringent  medicines  have  been  given  to  no 
purpofe.  This  has  often  been  obferved  in  the 
meafles, 

15.  It 


A    DEFENCE    OF    BLOOD-LETTING.  tgt 

15.  It  fuddenly  cures  the  intolerance  of  light 
which  accompanies  many  of  the  inflammatory  ilates 
of  fever, 

16.  It  removes  coma.  Mr.  Henry  Clymer  was 
fuddenly  relieved  of  this  alarming  fymptom  in  the 
fever  of  1794,  by  the  lofs  of  twelve  ounces  of 
blood. 

17.  It  induces  fleep.  This  effe£l:  of  bleeding  is 
fo  uniform,  that  it  obtained,  in  the  year  1794,  the 
name  of  an  anodyne  in  feveral  families.  Sleep 
fometimes  ftole  upon  the  patient  while  the  blood 
was  flowing. 

18.  It  prevents  elFufions  of  ferum  and  blood. 
Haemorrhages  feldom  occur  where  bleeding  has  been 
fuflEciently  copious. 

19.  It  belongs  to  this  remedy  to  prevent  the 
chronic  difeafes  of  cough,  confumption,  jaundice, 
abfcefs  in  the  liver,  and  all  the  different  ftates  of 
dropfy  which  fo  often  follow  autumnal  fevers. 

My  amiable  friend  Mrs  Lenox,  furniflied  an  ex- 
ception to  this  remark  in  the  year  1794.  After 
having  been  cured  of  the  yellow  fever  by  feven 
bleedings,  (he  was  affe(51:ed,  in  confequence  of  taking 

a  ride. 


Xg2  A   DEFENCE    OF   Bl^OOB-LETTING. 

a  ride,  with  a  flight  return  of  fever,  accompanied 
by  an  acute  pain  in  the  head,  which  I  was  afraid 
would  end  in  a  dropfy  of  the  brain.  As  her  pulfe 
was  tenfe  and  quick,  I  advifed  repeated  bleedings  to 
remove  it.  This  prefcription,  for  reafons  which  it 
is.  unneceiTary  to  relate,  was  not  followed  at  the 
time,  or  in  the  manner,  in  which  it  was  recom- 
mended. The  pain,  in  the  mean  time,  became 
more  alarming.  In  this  fituation,  two  phyficians 
were  propofed  by  her  friends  to  confult  with  me. 
I  obje6led  to  them  both,  becaufe  I  knew  their  prin- 
ciples and  modes  of  pra^ice  to  be  contrary  to  mine, 
and  that  they  %vcre  propofed  only  with  a  view  of 
WTefting  the  lancet  from  my  hand.  From  this  dellre 
of  avoiding  a  controverfy  with  my  brethren,  where 
conviclion  was  impoffible  on  either  fide,  as  well  as 
to  obviate  all  caufe  of  complaint  by  my  patient's 
friends,  I  olFered  to  take  my  leave  of  her,  and  to 
refign  her  wholly  to  the  care  of  the  two  gentlemen 
who  were  propofed  to  attend  her  with  me.  To  this 
Ihc  objected  in  a  decided  m.anner.  But  that  I  might 
not  be  fufpe£ted  of  an  undue  reliance  upon  my  own 
judgment,  I  propofed  to  call  upon  Dr.  Griflitts  or 
Dr.  Phyfick  to  aiTiil  me  in  my  attendance  upon  her. 
Both  thefe  phyficians  had  renounced  the  prejudices 
of  the  fchools  in  which  they  had  been  educated, 
and  had  conformed  their  principles  and  practice  to 
the  prefent  improving  flate  of  medical  fcience.  l^vly 
I  patient 


A    DEFENCE    OF    BLOOD-LETTING.  193 

patient  preferred  Dr.  Griffitts,  who  in  his  firjfl  vifit  to 
her,  as  foon  as  he  felt  her  pulfe,  propofed  more  bleed- 
ing. The  operation  was  performed  by  the  Doctor 
himfelf,  and  repeated  daily  for  five  days  afterwards. 
From  an  apprehenfion  that  the  diforder  was  fo  fixed 
as  to  require  fome  aid  to  blood-letting,  we  gave  her 
calomel  in  fuch  large  dofes  as  to  excite  a  falivation. 
By  the  ufe  of  thefe  remedies  Ihe  recovered  flowly, 
but  fo  perfe6lly  as  to  enjoy  her  ufual  health. 

20.  Bleeding  prevents  the  termination  of  the  in* 
flammatory,  in  the  gangrenous  and  chronic  flates  of 
fever.  This  etFe£i:  of  blood-letting  will  enable  us  to 
underfland  fome  thmgs  in  the  writings  of  Dr.  Mor^ 
ton,  and  Dr.  Sydenham  which  at  firfl  fight  appear  to 
be  unintelligible.  Dr.  Morton  defcribes  what  he 
calls  a  putrid  fever,  which  was  epidemic,  and  fatal 
in  the  year  1678.  Dr.  Sydenham,  who  pra6tifed 
in  London  at  the  fame  time,  takes  no  notice  of  this 
fever.  The  reafon  of  his  filence  is  obvious.  By 
copious  bleeding  he  prevented  the  fever  of  that  year 
from  running  on  to  the  gangrenous  ilate,  while  Dr. 
Morton  by  neglefting  to  bleed,  created  the  fuppofcd 
putrid  fevers  which  he  has  defcribed* 

It  has  been  common  to  charcre  the  friends  of 

o 

blood-letting  with  temerity  in  their  pra^liee.     From 
this  view  which  has  been  given  of  it,  it  appears  that 

K  it 


194  -^    DEFENCE    OF    BLOOD-LETTING* 

it  would  be  more  proper  to  afcribe  iiinidity  to  them, 
for  they  bleed  to  prevent  the  offenfive  and  diftrefT- 
ing  confequences  of  neglecting  it,  which  have  been 
mentioned. 

^i.  It  cures  without  permitting  a  fever  to  put 
on  thofe  alarming  fymptoms,  which  excite  conflant 
apprehenfions  of  danger  and  death  in  the  minds  of 
patients  and  their  friends.  It  is  becaufe  thefe 
alarming  fymptoms  are  prevented,  by  bleeding, 
that  patients  are  fometimes  unwilling  to  believe 
they  have  been  cured  by  it,  of  a  malignant  fever. 
Thus  the  Syrian  Leper  of  old,  viewed  the  water  of 
Jordan  as  too  fimple,  and  too  cdmmon  to  cure  a  for- 
midable difeafe,  without  recollefting  that  the  reme- 
dies for  the  greatefl  evils  of  life  are  all  fimple,  and 
within  the  power  of  the  grcateil  part  of  mankind. 

22.  It  prepares  the  way  for  the  fuceefsful  ufe  of 
the  bark  and  other  tonic  remedies,  by  deflroying, 
or  fo  far  weakning,  a  morbid  aflion  in  the  blood- 
velTels,  that  a  medicine  of  a  moderate  flimulus  after- 
wards exceeds  it  in  force,  and  thereby  reflorea 
equable  and  healthy  a£lion  to  the  fyftem. 

23.  Bleeding  prevents  relapfes.  It  moreover 
prevents  that  predifpofition  to  the  intermitting,  and 
pleuritic  flates  of  fever  whioh  fo  frequently  attack 

perfons 


A    DEFENCE    OF    BLOOD-LETTING.  195 

perfons  in  the  fpring,  who  have  had  the  bilious  re- 
mitting  fever  in  the  preceding  autumn. 

But  great  and  numerous  as  the  advantages  of 
blood-letting  are  in  fevers,  there  have  been  many- 
objections  to  it.  I  fhall  briefly  enumerate,  and  en- 
deavour to  refute  the  errors  upon  this  fubjeCt. 

Blood-letting  has  been  forbidden  by  phyficians, 
by  the  follov^ing  circumilances,  and  ftates  of  the 
fyilem. 

I.  By  warm  weather.  Galen  bled  in  a  plague, 
and  Ar^teus  in  a  bilious  fever,  in  a  warm  cli- 
mate. Dr.  Sydenham  and  Dr.  Hillary,  inform  us 
that  the  moil:  inflammatory  fevers  occur  in,  and  fuc- 
ceed  hot  weather.  Dr.  C leghorn  prefcribed  it 
copioufly  in  the  warm  months,  in  Minorca.  Dr. 
Mofely  cured  the  yellow  fever  by  this  remedy  in 
Jamaica.  Dr.  Broadbelt  and  Dr.  Wefl:on  in  the 
fame  Ifland  have  lately  adopted  his  fuccefsful  prac- 
tice. Dr.  Defportes  fpeaks  in  the  highefl  terms 
of  it  in  all  the  inflammatory  difeafes  of  St.  Domingo. 
He  complains  of  the  negle£l  of  it  in  the  rheumatifm, 
in  confequence  of  which  he  fays,  the  difeafe  pro- 
duces abfceffes  in  the  lungs.*     I  have  never  in  any 

*  P.  35. 
N  2  vear 


ig6  A    DEFENCE    OF    BLOOD-LETTING* 

year  of  my  praftice,  been  retrained  by  the  heat  of 
fummer  in  the  ufe  of  the  lancet,  where  the  pulfe  has 
hidicated  it  to  be  neceffary,  and  have  always  found 
the  fame  advantages  from  it,  as  when  I  have  pre- 
fcribcd  it  in  the  winter  or  fpring  months* 

The  relaxation  and  debility  of  the  body  in  warm 
weather,  and  in  hot  climates,  has  not  been  underflood 
until  lately,  to  be  of  the  indiredl  kind.  Of  courfe, 
inilead  of  forbidding,  it  requires  depletion  to  remove 
it.  It  is  leiTencd  at  all  times  by  abflemious  living, 
and  by  gentle  dofes  of  phyfic,  but  when  the  flimulus 
of  a  fever  is  added  to  that  of  the  heat  of  the  fun,, 
blood-letting  is  often  more  neceffary  to  remove  it, 
than  it  is  in  cool  weather,  or  in  temperate  climates* 

2.  Being  born,  and  having  lived  in  a  warm  cli- 
mate. This  is  fo  far  from  being  an  obje£i:ion  to 
blood-letting  in  an  inflammatory  difeafe,  that  it  ren- 
ders it  more  neceffary.  I  think  I  have  lofl  feveral 
Wefl  India  patients  from  the  influence  of  this 
error. 

3.  Great  apparent  weaknefs.  This,  in  acute  and 
violent  fevers  is  always  of  the  indiredl:  kind.  It  is 
induced  by  prefTure  upon  the  fources  of  ftrength  in 
the  mufcles.  It  refembles  in  fo  many  particulars 
that  weaknefs,  which  is  the  cSc£t  of  the  abflra^ion 

of 


A    DEFENCE    OF    BLOOD-LETTtNG.  I97 

of  ftlmulus,  that  it  is  no  wonder  they  have  been 
confounded  by  phyficians.  This  famenefs  of  fymp- 
toms  from  oppolite  flates  of  the  fyflem  is  taken 
notice  of  by  Hippocrates.  He  defcribes  convulfions, 
and  particularly  a  hiccup  as  occurring  equally  from 
repletion  and  inanition  which  anfwer  to  the  modern 
terms  of  indire^l,  and  dire(5l  debility.  The  natural 
remedy  for  the  former  is  depletion,  and  no  mode 
of  depleting  is  fo  efFe(^ual  or  fafe  as  blood-letting. 
But,  the  great  objeftion  to  this  remedy  is  when  the 
inflammatory  (late  of  fever,  affe^ls  perfons  of  delicate 
conflitutions,  and  fuch  as  have  long  been  fubje<fi:  to 
direfl  debility  of  the  chronic  kind.  In  this  flate  of 
the  fyllcm,  there  is  the  fame  morbid  and  preter- 
natural a(5lion  in  the  blood- veiTeis,  that  there  is  in 
perfons  of  robufl:  habits,  and  the  fame  remedy  is 
neceiTary  to  fubdue  it  in  both  cafes.  It  is  fometimes 
indicated  in  a  larger  quantity  in  weakly,  than  in 
robufl  people,  by  the  plethora  which  is  more  eafily 
induced  in  their  relaxed,  and  yielding  blood- veiiels, 
and  by  the  greater  facility  with  which  ruptures  and 
cffufions  take  place  in  their  vifcera.  Thus  it  is  more 
nccelTary  to  throw  overboard,  a  large  part  of  the 
cargo  of  an  old  and  leaky  velTcl  in  a  ftorm,  than  of 
a  new  andftrong  one.  I  know  that  vomits,  purges, 
fweats,  and  other  evacuating  remedies,  are  preferred 
to  bleeding  in  weakly  conflitutions,  but  I  hope  to 
flicw  hereafter,  that  bleeding  is  not  only  more  ef- 

N  3  fcflual, 


198  A    DEFENCE    OF    BLOOD-LETTIN(^. 

fe6!:ual,  but  more  fafe  in  fuch  habits,  than  any  other 
depleting  remedy. 

4.  Infancy  and  childhood.  This  is  fo  far  from 
being  an  objection  to  bleeding,  that  the  excitable 
ftate  of  the  blood-veiTels  in  thofe  periods  of  life, 
renders  it  peculiarly  neceflary  in  their  inflammatory 
difeafes.  Dr.  Sydenham  bled  children  in  the  hoop- 
ing cough,  and  in  dentition.  I  have  followed  his 
practice,  and  bled  as  freely  in  the  inflammatory  flate 
of  fever  in  infancy  as  in  middle  life.  I  bled  my 
eldeft  daughter  vi^hen  fhe  was  but  fix  weeks  old, 
for  convulfions  brought  on  by  an  excefTive  dofe  of 
laudanum  given  to  her  by  her  nurfe  ;  and  I  bled  my 
youngeft  fon  twice  before  he  was  two  months  old, 
for  an  inflammatory  fever  which  fell  upon  his  lungs 
and  bowels.  In  both  cafes,  life  appeared  to  be  faved 
by  this  remedy. 

5.  Old  age.  The  increafe  of  appetite  in  old 
people,  their  inability  to  ufe  fufiicient  exercife, 
whereby  their  blood- vefl^els  become  relaxed,  ple- 
thoric and  excitable,  and  above  all,  the  tranflation 
of  the  flrength  of  the  mufcles  to  the  arteries,  and  of 
plethora  to  the  veins,  all  indicate  bleeding  to  be 
more  neceflfary  (in  equal  circumftances)  in  old  than 
in  middle  aged  people.  I  am  not  the  author  of  this 
opinion,     Botallus  left  a  teflimony  in  favor  of  it 

nearly 


A    DEFEKCE    OF   BLOOD-LETTING.  I99 

nearly  200  years  ago,*  and  it  has  fmce  been  con- 
firmed by  the  experience  of  Hoffman,  and  many  other 
phyficians.  An  ignorance  of,  or  inattention  to  this 
change  in  the  ftate  of  the  blood-veffels,  in  perfons 
in  the  decHne  of  life,  and  the  negle6l  of  the  only 
remedy  indicated  by  it,  is  probably  the  reafon  why 
difeafes  often  prove  fatal  to  them,  which  in  early, 
or  middle  life  cured  themfelves,  or  yielded  to  a  fmgle 
dofe  of  phyfic,  or  a  few  ounces  of  bark. 

6.  The  time  of  menftruation.  The  fyilem  during 
this  period  is  plethoric  and  excitable,  and  of  courfe 
difpofcd  to  a  violent  degree  of  inflammatory  fever, 
from  all  the  caufes  which  excite  it.  Bleeding  therefore 
is  more  indicated  in  an  inflammatory  flate  of  fever, 
at  this  time,  than  at  any  other.  Formerly  the  na- 
tural difcharge  from  the  uterus  was  trufl:ed  to,  to 
remove  a  fever  contradled  during  the  time  of  men- 
ftruation.  But  v/hat  relief  can  the  difcharge  of 
four  or  ^YC  ounces  of  blood  from  the  uterus  afford, 
in  a  fever  which  requires  the  iois  of  50,  or  perhaps 
of  an  100  ounces  to  cure  it? 

7.  Pregnancy.  The  difl:ention  induced  upon 
the  uterus  dire(^tly,  and  indirectly  upon  the  whole 

"^  Magis  effe  adjuvandos  fenes,  miffione  fangulnis  dum 
morbus  poftulat,  aut  corpus  eorum  habitus  malus  eft,  quara 
ubi  hac  (quod  abfonum  videbltuv)  juvenlhus  conlingunt. 

Dc  Cur.  per  Sang,  miffionem,  cap.  11.  §  n. 
N  4  fyfl:em 


200  A    DEFENCE    OF    BLOOD-LETTING. 

fyflem  by  the  foetus,  renders  bleeding  in  the  inflam- 
matory itate  of  fever,  more  neceflary  than  at  other 
tirnes.  I  have  elfewhere  mentioned  the  advantages 
pf  bleeding  pregnant  women,  in  the  yellow  fever. 
I  did  not  learn  the  advantages  of  the  pra<?i:ice  in  that 
difeafe.  I  bled  Mrs.  Philler  1 1  times  in  feven  days, 
in  a  pleurify  during  her  pregnancy,  in  the  month  of 
March  1783.  M^s.  Fifs,  wa.s  bled  13  times  in 
the  fpring  of  1783  ;  and  Mrs.  Kirby  16  times  in  the 
fame  condition  by  my  orders  in  the  winter  of  1786, 
m  a  fiinllar  difeafe.  All  thefe  women  recovered, 
and  the  children  they  carried  during  their  ilinefs, 
are  at  this  time  alive,  and  in  good  health. 

8.  Fainting  after  bleeding.  This  fymptom  is 
accidental  in  many  people.  No  inference  can  be 
drawn  from  it  againil  blood-letting.  It  often  occurs 
after  the  iirfl  and  fecond  bleedings  in  a  fever,  but 
in  no  fubfequent  bleeding,  though  it  be  repeated 
a  dozen  times.  Of  this  I  faw  feveral  inflances  in 
the  yellow  fever  of  1794.  The  pulfe  during  the 
fainting,  is  often  tenfe  and  full. 

9.  Coldnefs  of  the  extremities,  and  of  the  whole 
body.  This  cold  ftate  of  fever  when  it  occurs  early, 
yields  more  readily  to  bleeding,  than  to  the  mofl 
cordial  medicines. 

10.  Sweats 


A    DEFENCE    OF    BLOOD-LETTING.  201 

10.  Sweats  are  fuppofed  to  forbid  blood-letting. 
I  have  feen  two  inflances  of  death,  from  leaving  a 
paroxyfm  of  malignant  fever  to  terminate  itfelf  by 
fweating.  Dr.  Sydenham  has  taught  a  contrary 
pratTtice  in  the  following  cafe.  "  While  this  con- 
ftitution  (fays  the  Doctor)  prevailed,  I  was  called 
to  Dr.  Morice,  who  then  praflifcd  in  London.  He 
had  this  fever,  attended  v/ith  profufe  fweats  and  nu- 
merous petechice.  By  the  confent  of  fome  other 
phyficians,  our  joint  friends,  he  was  blooded,  and 
rofe  from  his  bed,  his  body  being  firil  wiped  dry. 
He  found  immediate  relief  from  the  ufe  of  a  cooling 
diet  and  medicines,  the  dangerous  fy mptoms  foon 
going  off;  and  by  continuing  this  method  he  reco- 
vered in  a  few  days.^'  *  In  the  fame  fever,  the 
Dodor  adds  further,  "  For  though  one  might  ex- 
ped  great  advantages  in  purfuing  an  indication 
taken  from  what  generally  proves  ferviceable  (viz. 
fweafmg)^  yet  I  have  found  by  conftant  experience, 
that  the  patient  not  only  finds  no  relief,  but  con- 
trary wife,  is  more  heated  thereby ;  fo  that  fre* 
quently  a  delirium,  petechise,  and  other  very  dan- 
gerous fymptoms  immediately  fucceed  fuch^^^/^."t 

Morgagni  defcribes  a  malignant  fever  which  pre- 
vailed in  Italy,  in  which  the  patients  died  in  pro- 
fufe fweats,  while  their  phyficians  were  looking  for 

*  Wallis's  edition,  Vol,  I,  p.  210.        f  Vol.  I.  p.  208; 

a  criiis 


202  A    DEFENCE    OF    BLOOD-LETTING. 

a  crifis  from  them.     Bleeding  would  probably  have 
checked  thefe  fweats  and  cured  the  fever. 

1 1 .  DifTolved  blood,  and  an  abfence  of  an  inflam- 
matory crufl  on  its  craflamentum.  I  {hall  hereafter 
place  diiTolved  blood  at  the  highefl  point  of  a  fcale, 
which  is  intended  to  mark  the  different  degrees  of 
inflammatory  diathefls  in  the  fyflem.  I  have  men- 
tioned in  the  inquiry  into  the  proximate  caufe  of 
fever,  that  it  is  the  efle61:  of  a  tendency  to  a  palfy, 
induced  by  the  violent  force  of  impreflion  upon  the 
blood-veflTels.  This  appearance  of  the  blood  in  cer- 
tain flates  of  fever,  infl:ead  of  forbidding  bleeding, 
is  the  mod  vehement  call  of  the  fyflem  for  it.  Nor 
is  the  abfence  of  a  crufl  on  the  crafl!amentum  of  the 
blood,  a  proof  of  the  abfence  of  inflammatory  dia- 
thefis,  or  a  iignal  to  lay  afide  the  lancet.  On  the 
contrary,  I  fliall  fliew  hereafter,  that  there  are  feve- 
ral  appearances  of  the  blood  which  indicate  more 
morbid  action  in  the  blood-veflfels  than  a  iizy  or  in- 
flammatory criifl. 

12.  An  undue  proportion  of  ferum  to  crafTamen- 
tum  in  the  blood.  This  predominance  of  water  in 
the  blood  has  often  checked  fufflcient  blood-letting. 
But  it  iliould  be  conflantly  difregarded  v/liile  it  is 
attended  with  thofe  flates  of  pulfe  (to  be  mxentioned 
hereafter)  which  require  bleeding. 

13.  The 


A    DEFENCE    OF    BLOOD-LETTING.  SOJ 

13.  The  prefence  of  petechias  on  the  ilcin.  Thefe, 
I  have  elfewhere  faid,  are  the  eiFe<^s  of  the  gangre- 
nous flate  of  fever.  Dr.  Sydenham  and  Dr.  tie 
Haen  have  taught  the  fafety  and  advantage  of 
bleeding,  when  thefe  fpots  are  accompanied  by 
an  aftive  pulfe.  A  boy  of  Mr.  John  Carrol  owes 
his  recovery  from  the  fmall-pox  to  the  lofs  of 
fifty  ounces  of  blood,  by  five  bleedings,  at  a  time 
v/hen  nearly  every  pock  on  his  arms  and  legs  had 
a  purple  appearance.  Lewis  XIV.  was  bled  five 
times  in  the  fmall-pox,  when  he  was  only  thirteen 
years  of  age,  and  thereby  probably  faved  from  the 
grave,  to  the  great  honour  and  emolument  of  the 
fingle  phyfician  who  urged  it  againfl  the  advice  of 
all  the  other  phyficians  of  the  court.  Dr.  Cleghorn 
mentions  a  fingle  cafe  of  the  fuccefs  of  bleeding  in 
the  petechial  fmall-pox.  His  want  of  equal  fuccefs 
afterwards,  in  fimilar  cafes,  was  probably  occafioned 
by  his  bleeding  too  fparingly,  that  is,  but  three  or 
four  times. 

Abfcefies  and  fore  breads,  which  accompany  or 
fucceed  fever,  are  no  obje6lions  to  blood-letting, 
provided  the  pulfe  indicates  the  continuance  of  inflam- 
matory diathefis.  They  depend  frequently  upon  the 
fame  ilate  of  the  fyflem,  as  livid  effufions  on  the  /kin. 

14.  The  long  duration  of  fever.  Inflammatory 
diathefis  is  often  protracted  for  many  weeks,  in  the 

chronic 


2.04  ^"^    DEFENCE    OF    BLOOD-LETTING. 

chronic  ftate  of  fever.  It  moreover  frequently  Re- 
vives after  having  difappeared,  from  an  accidental 
flimulus  aiTcifting  fome  part  of  the  body,  particularly 
the  lungs  and  brain.  I  bled  a  young  man  of  James 
Cameron,  in  the  autumn  of  1794,  four  times  be- 
tween the  20th  and  30th  days  of  a  chronic  fever, 
in  confequence  of  a  pain  in  the  fide,  accompanied 
hj  a  tenfe  pulfe,  which  fuddenly  came  on  after  the 
20th  day  of  his  difeafe.  His  blood  was  fizy.  His 
pain  and  tenfe  pulfe  were  fubdued  by  the  bleeding, 
and  he  recovered.  I  wifli  this  cafe  to  be  attended 
to  by  young  pracl:itioners.  The  pulmonary  con- 
fumption  is  often  the  effed  of  a  chronic  fever,  ter- 
minating with  frefh  inflammatory  fymptoms,  by  effu- 
fions  in  the  lungs.  It  may  eafily  be  prevented,  by 
forgetting  the  number  of  the  days  of  our  patient's 
fever,  and  treating  the  pulmonary  aire(ftion  as  if  it 
were  a  recent  complaint. 

15.  Tremors  and  flight  convulfions  in  the  limbs. 
Eark,  wine,  laudanum,  and  miiik  are  generally  pre- 
fcribed  to  remove  thefe  fymptoms ;  but  to  be  effec- 
tua!,  the}'-  ihould,  in  mofl  cafes,  be  preceded  by  the 
lofs  of  a  few  ounces  of  blood. 

16,  Bleeding  is  forbidden   after  the  5th  or  7th 
day  in  a  pkurify.     This  prohibition  was  introduced 
into  medicine  at  a  time   when  a  fear  was  enter- 
tained 


A    DEFENCE    OF    BLOOD-LETTING.    '       205 

talned  of  arrefling  the  progrefs  of  nature  in  prd- 
paring  and  expelling  morbific  matter  from  the  fyf- 
tem.  From  repeated  experience  I  can  affert,  that 
bleeding  is  llife  in  every  flage  of  pleurify  in  which 
there  is  pain  and  a  tenfe  and  opprefTed  pulfe  ;  and 
that  it  has,  when  ufed  for  the  firfl  time  after  the 
5th  and  7th  days,  faved  many  lives. 

17.  The  lofs  of  a  fufEcIent  quantity  of  blood  is 
often  prevented  by  patients  being  apparently  worfey 
after  the  firfl  or  fecond  bleeding.  This  change  for 
the  worfe  iliews  itfelf  in  fome  one  or  more  of  the 
following  fymptoms,  viz.  increafe  of  heat,  chills, 
delirium,  hemorrhages,  convulfions,  naufea,  vomit- 
ing, faintnefs,  coma,  great  weaknefs,  pain,  a  tenfe 
after  a  foft  pulfe,  and  a  reduction  of  it  in  force 
and  frequency.  They  are  all  occafioned  by  the  fyf- 
tem  rifmg  fuddenly  from  a  ftate  of  extremxC  de- 
prefiion,  in  confequence  of  the  abflracSiion  of  the 
preiTure  of  the  blood  to  a  ftate  of  vigour  and  ac- 
tivity, fo  great  in  fome  inftances,  as  to  re-produce 
a  depreflion  below  what  exifted  in  the  fyflem  be* 
fore  a  vein  was  opened ;  or  it  is  occafioned  by  a 
tranflation  of  morbid  a6lion  from  one  part  of  the 
body  to  another. 

The  chills  which  follow  bleeding  are  the  effe<5^s 
ef  a  change  in  the  fever,  from  an  uncommon  to  a 

common 


206  A    DEFENCE    OF    BLOOD-LETTING. 

common  ftate  of  malignity.  They  occur  chiefly  in 
thofe  violent  cafes  of  fever  which  come  on  without 
a  chiliy  fit. 

The  haemorrhages  produced  by  bleeding,  are 
chiefly  from  the  nofe,  hsemorrhoidal  veflels,  or  ute- 
rus, and  of  courfe  are,  for  the  mod  part,  fafe. 

Uncommon  weaknefs  fucceeding  blood-letting,  is 
the  effect  of  fudden  indireci:  debility  induced  upon 
the  whole  fyflem,  by  the  caufe  before  mentioned, 
or  of  a  fudden  tranflation  of  the  excitement  of  the 
mufcles  into  the  blood-veffels,  or  fome  other  part  of 
the  body.  Thefe  fymptoms,  together  with  all  the 
others  which  have  been  mentioned,  are  fo  far  from 
forbidding,  that  they  all  mofl:  forcibly  indicate  a  re- 
petition of  blood-letting. 

I  fiiall  briefly  illuftrate,  by  the  recital  of  three 
cafes,  the  good  effe^ls  of  bleeding,  in  removing  pain, 
and  the  preternatural  flownefs,  and  weaknefs  of  the 
pulfe,  when  produced  by  the  ufe  of  that  remedy. 

In  the  month  of  June  of  1795, 1  vifited  Dr.  Say  in 
a  malignant  fever,  attended  with  pleuritic  fymptoms, 
in  confultation  with  Dr.  Phyfick.  An  acute  pain  in 
his  head  followed  fix  fucceiflve  bleedings.  After  a 
feventh  bleeding  he  had  no  pain.     His  fever  foon 

afterwards 


A    DEFENCE    OF    BLOOD-LETTINO.  lOJ 

afterwards  left  him.  In  thus  perfevering  in  the 
ufe  of  a  remedy  which,  for  feveral  days,  appeared  to 
do  harm,  we  were  guided  wholly  by  the  flate  of  his 
pulfe,  which  uniformly  indicated,  by  its  force,  the 
neceflity  of  more  bleeding. 

In  the  autumn  of  1794,  I  was  fent  for  to  vifit  Sa- 
muel Bradford,  a  young  man  of  about  20  years  of 
age,  fon  of  Mr.  Thomas  Bradford,  who  was  ill  with 
the  reigning  malignant  epidemic.  His  pulfe  was  at 
80.  I  drew  about  1 2  ounces  of  blood  from  him.  Im- 
mediately after  bis  arm  was  tied  up,  his  pulfe  fell  to 
60  flrokes  in  a  minute.  I  bled  him  a  fecond  time,  but 
more  plentifully  than  before,  and  thereby,  in  a  few 
mJnutes,  brought  his  pulfe  back  again  to  80  flrokes 
in  a  minute.  A  third  bleeding  the  next  day,  aided 
by  the  ufual  purging  phyfic,  cured  him  in  a  few  days. 

In  the  month  of  March  1795,  Dr.  Phyfick  re- 
queued me  to  vifit,  with  him,  Mrs.  Fries,  the  wife  of 
Mr.  John  Fries,  in  a  malignant  fever.  He  had  bled 
her  four  times.  After  the  fourth  bleeding,  her  pulfe 
fuddenly  fell,  fo  as  fcarce  to  be  perceptible.  I  found 
her  hands  and  feet  cold,  and  her  countenance 
ghaftly,  as  a  perfon's  in  the  lafl  moments  of  life.  In 
this  alarming  fituation,  I  fuggefled  nothing  to  Dr. 
Phyfick  but  to  follow  his  judgment,  for  I  knew  that 
he  was  mailer  of  that  law  of  the  animal  economy 

which 


208  A    DEFENCE    OF    BLOOD-LETTING. 

which  refolved  all  her  fymptoms  into  an  oppreffed 
ftate  of  the  f)  item.  The  Dodor  decided  in  a  mo- 
ment in  favour  of  more  bleeding;.  During  the  flow- 
ing of  the  blood,  the  puife  rofe.  At  the  end  of 
three,  ten,  and  feventeen  hours  it  fell,  and  rofe 
again  by  three  fucceffive  bleedings,  in  all  of  which  fiie 
loft  about  thirty  ounces  o^fizy  blood.  So  great  was 
the  vigour  acquired  by  the  pulfe,  a  few  days  after 
the  paroxyfms  of  depreiTion,  which  have  been  de- 
fcribed,  were  relieved. ^  that  it  required  feven  more 
bleedings  to  fubdue  it.  I  wiili  the  hiilory  of  thefe 
two  cafes  to  be  carefully  attended  to  by  the  reader. 
I  have  been  thus  minute  in  the  detail  of  them,  chiefly 
becaufe  I  heard  of  feveral  praftitioners  who,  I  am 
perfuaded,  have  lofl  patients  Ly  attempting  to  raife 
a  pulfe  that  had  been  deprelTed  by  bleeding,  in  a 
malignant  fever,  by  means  of  cordial  medicines,  in- 
ftead  of  the  repeated  ufe  of  the  lancet.  The  prac- 
tice is  ftriftly  rational  j  for  in  proportion  as  the 
blood-veflfels  are  weakened  by  preflure,  the  quantity 
of  blood  to  be  moved  fliould  be  proportioned  to  the 
diminution  of  their  ilrength. 

It  is  remarkable  that  this  deprefl^ed  ftate  of  the 
pulfe,  whether  induced  by  a  paroxyfm  of  fever,  or 
by  blood-letting,  is  fometimes  attended  with  a  flrong 
pulfation  of  the  arteries  in  the  bowels  and  head. 

A  I  have 


A    DEFENCE    OF    BLOOD-JLETTING.  20^ 

'  I  ha^^e  mentioned  among  the  apparent  bad  efFecls 
of  bleeding,  that  it  fometnncs  changes  a  foft  into  a 
tcnfe  pulfe.  Of  this  I  faw  a  remarkable  inllancc 
in  Captain  John  Barry  in  the  autumn  of  1795. 
After  the  lofs  of  130  ounces  of  blood  in  a  malig- 
nant yellow  fever,  his  pulfe  became  fo  foft  as  to  in- 
dicate no  more  bleeding.  In  this  fituanon  he  re- 
mained for  three  days,  but  without  rnendino^  as 
rapidly  as  I  expeftcd  from  the  fcate  of  his  pulfe. 
On  the  4th  day  he  had  an  hreniorrhage  from  his 
bowels,  from  which  he  lofh  above  a  pint  of  blood. 
His  pulfe  now  fuddenly  became  tenfc,  and  continued 
fo  for  two  or  three  days.  I  afcribed  this  change  in 
his  pulfe  to  the  vefTels  of  the  bowels,  which  had 
been  oppreiTed  by  congeflion,  being  fo  much  re- 
lieved by  the  hcemorrhage,  as  to  refume  an  in- 
flammatory a£l:ion.  It  is  thus  we  fee  the  blood-vef- 
fels,  in  a  common  phlegmon,  travel  back  again  from 
a  tendency  to  mortification,  to  the  red  colour  and 
pain  of  commion  inflammation. 

From  a  review  of  the  commotions  excited  in  the 
fyllem  by  bleeding,  a  reafon  may  be  given  Vvhy  the 
phyfitians  who  do  not  bleed  in  the  depreffed  Hate 
of  the  pulfe,  have  {o  few  pa.tients  in  what  they  call 
malignant  fevers,  compared  with  thofe  who  ufe  a 
contrary  practice.  The  difeafe,  in  fuch  cafes,  being 
locked  up,  is  not  permitted  to  unfold  its  true  cha- 

o  radler ; 


210  A    DEFENCE    OF    BLOOt)-LETTING. 

ra£ler  ;  and  hence  patients  are  faid  to  die  of  apo- 
plexy, lethargy,  colera,  dyfentery,  or  nervous  fe- 
ver, who,  under  a  different  treatment,  would  have 
exhibited  all  the  marks  of  an  ordinary  malignant 
fever. 

In  obviating  the  objections  to  blood-letting  from 
its  apparent  evils,  I  have  faid  nothing  of  the  appa- 
rent bad  effefts  of  other  remedies.  A  naufea  is 
often  rendered  worfe  by  an  emetic,  and  pains  in  the 
bowels  are  increafed  by  a  purge.  But  thefe  reme- 
dies notwithflanding  maintain,  and  juilly  too,  a  high 
character  among  phyficians. 

1 8.  Bleeding  has  been  accufed  of  bringing  on  a 
nervous,  or  the  chronic  fl:ate  of  fever.  The  ufe  of 
this  remedy,  in  a  degree  fo  moderate  as  to  obviate 
the  putrid  or  gangrenous  flate  of  fever  only,  may 
induce  the  chronic  Hate  of  fever ;  for  it  is  the 
-cffe6l,  in  this  cafe,  of  the  remains  of  inflammatory 
diathefis  in  the  blood-velTels ;  but  when  blood  is 
•drawn  proportioned  to  the  morbid  action  in  the  (jf- 
tem,  it  is  impoffible  for  a  chronic  fever  to  be  pro- 
duced by  it.  Even  the  excefiive  ufe  of  blood-let- 
ting, however  injurious  it  may  be  in  other  refpe6ls, 
cannot  produce  a  chronic  fever,  for  it  dellroys  mor- 
bid a£lion  altogether  in  the  blood-veffels. 

19.  Bleed- 


A   "DEFENCE    OF    BLOOD-LETTING*  CI  I 

ig.  Bleeding  has  been  charged  with  being  3 
weakening  remedy.  I  grant  that  it  is  fo,  and  in 
this  its  merit  chiefly  confifts.  The  morbid  action  of 
the  blood- vefTels  mud  be  fubdued  in  part,  in  an  in- 
flammatory fever,  before  tonic  remedies  can  be 
given  with  fafety  or  advantage.  Now  this  is  ufualiy 
attempted  by  depleting  medicines,  to  be  mentioned 
hereafter,  or  it  is  left  to  time  and  nature,  all  of 
w^hich  are  frequently  either  deficient  or  exceifive  in 
their  operations  ;  whereas  bleeding,  by  fuddenly  re- 
ducing the  morbid  a^lion  of  the  blood-velTels  to  a 
willied-for-point  of  debility,  faves  a  great  and  un- 
necelTary  wafte  of  excitability,  and  thus  prepares 
the  body  for  the  exhibition  of  fuch  cordial  remedies 
as  are  proper  to  remove  the  debility  which  predif- 
pofed  to  the  fever. 

20.  It  has  been  fald  that  bleeding  renders  the 
habitual  ufe  of  it  neceffary  to  health  and  life.  This 
objection  to  blood-letting  is  founded  upon  an  igno- 
rance of  the  difference  between  the  healthy  and  mor^ 
bid  aftion  of  the  blood-veffels.  Where  blood  is 
drawn  in  health,  fuch  a  relaxation  is  induced  in  the 
blood- vefTels,  as  to  favour  the  formation  of  ple- 
thora, which  may  require  habitual  bleeding  to  re- 
move it ;  but  where  blood  is  drawn  only  in  the  in- 
flammatory ftate  of  fever,  the  blood-vefTels  are  re- 
duced froiii  a  morbid  decree  of  flren^th  to  that 

^  a  which 


212  A    DEFENCE    OF    BLOOD-LETTING. 

which  is  natural  ;  in  which  ftatc  no  predifpofition 
to  plethora  is  created,  and  no  foundation  laid  for  pe-^ 
riodical  blood-letting, 

21.  It  has  been  faid  that  bleeding,  more  efpc- 
cially  where  it  is  copious,  predifpofes  to  elFufions  of 
lerum  in  the  lungs,  chefl,  bowels,  limbs,  and  brain.  In 
replying  to  this  objedion  to  bleeding,  in  my  public 
leclures,  I  h?tve  addreiTed  by  pupils  in  the  following 
language  :  ''  Aik  the  poor  patients  who  come  pant- 
ing to  the  door  of  our  hofpital,  with  fwelled  legs  and 
hard  bellies,  every  fall,  whether  they  have  been  too 
copioufly  bled,  and  they  v/ill  all  tell  you,  that  no 
kncet  has  come  near  their  arms.     Aik  the  parents 
who  flill  mourn  the  lofs  of  children  who  iiave  died 
in  our  city  of  the  internal  dropfy  of  the  brain,  whe- 
ther they  were  deflroyed  by  exceiTive  blood-letting  ? 
If  the  remembrance  of  the  acute  fufferings  which 
accom.panied  their  ficknefs    and   death  will  permit 
thefe  parents  to  fpeak,  they  will  tell  you,  that  every 
medicine,   except  bleeding,  had  been  tried   to   no 
purpofe  in  their  children's  diforders.     Go  to  thofe 
families  m  which  I  have  praclifed  for  many  years, 
sind  inquire,  whether  there  is  a  living  or  a  dead 
inllance  of  dropfy  having  followed,   in  any  one  of 
them,  the  ufe  of  my  lancet  ?     Let  the  undertakers 
and  grave-diggers  bear  witnefs  againfl  me,  if  I  have 
<sy€r,  in  the  courfs  q{  xny  practice,  conveyed  the 

body^ 


A    DEFENCE    OF    BLOOD-LETTING.  213 

Lody  of  a  fingle  dropfical  patient  into  their  hands, 
by  exceiTive  blood-letting  ?"  No.  Dropfies,  like 
abfcefles  and  gangrenous  eruptions  upon  the  flxin, 
arife,  in  moil  cafes,  from  the  wafit  of  fufficient 
bleeding  in  inflammatory  difeafes.  Debility,  when 
of  a  direct  kind,  whether  induced  by  art  or  nature, 
fcldom  difpofcs  to  efTufion.  Who  ever  heard  of 
dropfy  fucceeding  famine  ?  And  how  rarely  do  we 
fee  it  accompany  the  extreme  dire6l  debility  of  old 
age  ? 

"  If  ever  bleeding  kills,"  fays  Botallus,  either 
dire£i:iy  or  indire<5lly,  through  the  inllrumentality  of 
other  difeafes,  "  it  is  not  from  its  excefs,  but  be^ 
caufe  it  is  not  drawn  in  a  fufficient  quantity,  or  at 
a  proper  time."  *  And  again,  fays  this  excellent 
writer,  "  One  hundred  thoufand  men  periili  from 
the  want  of  blood-letting,  or  from  its  being  ufed 
out  of  time,  to  one  who  periflies  from  too  much 
bleeding,  prefcribed  by  a  phyfician.' 


j>  4- 


It  is  remarkable,  that  the  dread  of  producing  a 
dropfy  by  bleeding,  is  confined  chiefly  to  its  ufc  in 
malignant  fevers ;  for  the  men  who  urge  this  objec- 
tion to  it,  do  not  hefitate  to  draw  four  or  five  quarts 
•f  blood  in  the  cure  of  pleurify,  and  of  a  flrangu- 

*  Cap.  viil.  }  4.  •]•  Cap.  xxwl.   §  4. 

o  3  la  ted 


214  A    DEFENCE    OF    BLOOD-LETTING. 

lated  hernia.  The  habitual  aflbciation  of  the  lancet 
with  the  former  of  thofe  diforders,  has  often  caufed 
me  to  rejoice  when  I  have  heard  a  patient  complain 
of  a  pain  in  his  fide  in  a  malignant  fever.  It  infured 
to  me  his  confent  to  the  frequent  ufe  of  the  lancet, 
and  it  protected  me,  when  it  was  ufed  unfuccefs- 
fully,  from  the  clamours  of  the  public,  for  few  peo- 
ple cenfure  copious  bleeding  in  a  pleurify, 

22.  Evacuating  remedies  of  another  kind  have 
been  faid  to  be  more  fafe,  and  equally  effedual,  in 
reducing  the  inflammatory  ftate  of  fever.  I  fliall 
recapitulate  each  of  thofe  evacuating  remedies,  and 
then  draw  a  comparative  view  of  their  effeds  with 
blood-letting.     They  are, 

I.  Vomits. 

II.  Purges. 

III.  Sweats. 

IV.  Salivation-     And, 

V.  Bliflers. 

I.  Vomits  have  often  been   eirecl:ual  in  curing 
fevers  of  a  mild  character.     They  difcharge  olTen^ 

five 


A    DEFENCE    OF    BLOOD-LETTING.  215 

"five  and  flimulating  matters  from  the  flomach ;  they 
leiTen  the  fuhiefs  of  the  blood- velTels,  by  deter- 
mining the  ferum  of  the  blood  through  the  pores  ; 
and  they  equalize  the  excitement  of  the  fyflem,  by 
inviting  its  exceilive  degrees  from  the  blood-velTels 
to  the  llomach  and  mufcles.     But  they  are, 

1 .  Uncertain  in  their  operation,  from  the  torpor 
induced  by  the  fever  upon  the  flomach. 

2.  They  are  unfafe  in  many  conditions  of  the 
fyflem,  as  in  pregnancy  and  a  difpofition  to  apoplexy 
and  ruptures.  Life  has  fometimes  been  deflroyed 
by  their  inducing  cramp,  hemorrhage,  and  infiam- 
mation  in  the  flomach. 

3.  They  are  not  fubje6l  to  the  controul  of  a  phy- 
fician,  often  operating  more  or  lefs  than  was  intended 
by  him,  or  indicated  by  the  difeafe. 

4.  They  are  often  ineffectual  in  mild,  and  always 
fo  in  fevers  of  great  inflammatory  aClion. 

11.  Purges  are  ufeful  in  difcharging  acrid  faeces 
and  bile  from  the  bowels  in  fevers.  They  a6l  more* 
over  by  creating  an  artificial  weak  part,  and  thus 
invite  morbid  excitement  from  the  blood-veffels  to 
the  bowels.     They  likewife  leiTen  the  quantity  of 

«» 4.  blood. 


21^  A    DEFENCE    OF    ELOOD-LETTING. 

blood  by  preventing  fixfii  acceffions  of  chyle,  being 
added  to  it  ;  but  like  vomits  they  iire, 

1 .  Uncertain  in  their  operation ;  and  from  the 
f^me  caufe.  Many  ounces  of  falts  and  caHor  oil,  and 
whole  drachms  of  calomel  and  jalap,  have  often  been 
given,  without  efFe^t,  to  rem.ove  the  coflivenefs  which 
is  conne£l:ed  with  the  malignant  flate  of  fever. 

2.  They  are  not  fubje£l:  to  the  direction  of  a 
phyfician,  with  refpe^i:  to  the  time  of  their  opera- 
tion, or  the  quantity  or  quality  of  matter  they  arc 
intended  to  difcharee  from  the  bowels. 

3.  They  are  unfafe  in  the  advanced  flage  of 
fevers.  Dr.  Phyfick  informed  me  that  three  patients 
died  in  tbe  water  clofet  under  the  operation  of  purges 
in  St.  George's  hofpital  during  his  attendance  upon 
it.  I  have  feen  death  in  feveral  inflances  fucceed  a 
plentiful  fpontaneous  ilool  in  debilitated  habits. 

III.  Sweating  was  introduced  into  practice  at  a 
time  when  morbific  mxatter  was  fuppofed  to  be  the 
proximate  caufe  of  fever.  It  acls,  not  by  expelling 
any  thing  excluilvely  morbid  from  the  blood,  but 
by  abflradling  a  portion  of  its  fluid  parts,  and  thus 
reducing  the  aftion  of  the  blood-veifels.  This  mode 
of  curing  fever  is  ilill  fafliionable  in  genteel  life.     It 

excites 


A    DEFENCE    OF    BLOOD-LETTING.  2l*J 

€xcites  no  fear,  and  olTends  no  fenfc.  The  fwcating 
remedies  have  been  numerous,  and  fafliion  has 
reigned  as  much  among  them,  as  in  other  things. 
Alexipharmic  waters,  and  powders,  and  all  the 
train  oi  Ibdorific  medicines,  have  lately  yielded  to 
the  different  preparations  of  antimony,  particularly 
to  James's  powder.     I  object  to  them  all, 

1 .  Becaufe  they  are  uncertain  ;  large  and  re- 
peated dofes  of  them  being  often  given  to  no  purpofe. 

2.  Becaufe  they  are  flov/,  and  difagreeable, 
where  they  fucceed  in  curing  fever. 

3.  Becaufe,  like  vomits  and  purges,  they  are  not 
imder  the  dire£^ion  of  a  phyfician,  with  refped  to 
the  quantity  of  fluid  difcharged  by  them, 

4.  Becaufe  they  are  fometimes,  even  when  moH 
profufe,  ineffectual  in  the  cure  of  fever. 

5.  The  preparations  of  antimony  lately  employed 
for  the  purpofe  of  exciting  fweats,  are  by  no  means 
fafe.  They  fometimes  convulfe  the  (yflem  by  a 
violent  puking.  Even  the  boafled  James's  powder 
has  done  great  mifchief.  Dr.  Goldfmith  and  Mr. 
Howard,  it  \z  faid  were  deftroycd  by  it. 

IV.  Mcr- 


2lt  A    DEFENCE    OF    BLOOD-LETTING. 

IV.  Mercury,  the  Sampfon  of  the  Materia  Medica, 
after  havmg  fubdued  the  venereal  difeafe,  the 
tetanus,  and  many  other  formidable  diforders,  has 
lately  added  to  its  triumphs  and  reputation,  by  over- 
coming the  inflammatory  and  malignant  ilate  of 
fe^/er.  I  fliall  coniine  myfelf  in  this  place  to  its  de- 
pleting operation  when  it  afts  by  exciting  a  faliva- 
tion.  From  half  a  pound  to  two  pounds  of  fluid, 
are  difcharged  by  it  in  a  day.  The  depletion  in 
this  way  is  gradual,  whereby  fainting  is  prevented. 
By  exciting  and  inflaming  the  glands  of  the  mouth 
and  throat,  excitement  and  inflamm.ation  are  ab- 
i!ra£l:ed  from  more  vital  parts.  In  morbid  con- 
geilion  and  excitement  in  the  brain,  a  falivation  is 
of  eminent  fervice,  from  the  proximity  of  the  dif- 
charge  to  the  part  aifecled.  But  I  object  to  it  as 
an  exclufive  evacuant  in  the  cure  of  fever. 

1.  Becaufe  it  is  fometimies  impoflible  by  the 
largeil  dofes  of  mercury,  to  excite  it,  when  the 
exigencies  of  the  fyflem  render  it  moil  necefl^ary. 

2.  Becaufe  it  is  not  fo  quick  in  its  operation,  as 
to  be  proportioned  to  the  rapid  progrefs  of  the 
malii^nant  fl:ate  of  fever. 

3.  Becaufe  it  is  at  all  times  a  difagreeable,  and 
frequently  a  painful  remedy,  more  efpecially  where 
the  teeth  are  decayed. 

i..  Becaufe 


A    DEFENCE    OF    BLOOD-LET  TINC.  219 

4.  Becaufe  it  cannot  be  proportioned  in  its  dura- 
tion, or  in  the  quantity  of  fluid  difcharged  by  it,  to 
the  violence,  or  changes  in  the  fever. 

Dr.  Chifholm  relied,  for  the  cure  of  the  Boullam 
fever  at  Grenada,  chiefly  upon  this  evacuation.  I 
have  mentioned  the  ratio  of  fuccefs  which  attended 
it. 

V.  Blisters  are  ufeful  in  depleting  from  thofe 
parts  which  are  the  feats  of  topical  inflammation. 
The  relief  obtained  by  them  in  this  way,  more  than 
balances  their  flimulus  upon  the  whole  fyflem.  I 
need  hardly  fay,  that  their  effects  in  reducing  the 
morbid  and  exceflive  a£lion  of  the  blood -veflels  are 
very  feeble.  To  depend  upon  them  in  cafes  of 
great  inflammatory  a61:ion,  is  as  unwife,  as  it  would 
be  to  attempt  to  bale  the  water  from  a  leaky  and 
fmking  fliip  by  the  hollow  of  the  hand,  inflead  of 
difcharging  it  by  two  or  three  pumps. 

Abflemious  diet  has  fometimes  been  prcfcribed 
as  a  remedy  for  fever.  It  acls  direclly  by  the  ab- 
ftra^lion  of  the  flimulus  of  food  from  the  flomach, 
and  indire^ly  by  leflfening  the  quantity  of  blood.  It 
can  bear  no  proportion  in  its  efle6ls,  to  the  rapidity, 
and  violence  of  an  inflammatory  fever.  In  chronic 
fever  fuch  as  occurs  in  the  pulmonary  confumption, 

it- 


520  A    DEFENCE    OF    BLOOD-LETTIKG. 

it  has  often  been  tried  to  no  purpofe.  Long  before 
it  reduces  the  pulfe,  it  often  induces  fuch  a  relaxation 
of  the  tone  of  the  flomach  and  bowels  as  to  accelerate 
death.  To  depend  upon  it  therefore  in  the  cure 
of  inflammatory  fever  whether  acute  or  chronic,  is 
like  truding  to  the  rays  of  the  fun  to  exhale  the 
water  of  an  overflowing  tide,  inftead  of  draining  it 
off  immediately  by  digging  a  hole  in  the  ground. 

Bleeding  has  great  advantages  over  every  mode 
bf  depleting  that  has  been  mentioned. 

1.  It  abftracts  one  of  the  exciting  caufes,  viz.  the 
ftimulus  of  the  blood  from  the  feat  of  fever.  I  have 
ibrmerly  illullrated  this  advantage  of  blood-letting 
by  comparing  it  to  the  abilra£lion  of  a  grain  of  fand 
from  the  eye  to  cure  an  opthalmja.  The  other 
depleting  remedies  are  as  indirecl:  and  circuitous  in 
their  operation  in  curing  fever,  as  vomits  and 
purges  would  be  to  remove  an  inflammation  in  the 
eye,  wliile  the  grain  of  fand  continued  to  irritate  it. 

2.  Blood-letting  is  quick  in  its  opera.tion,  and  may 
be  accommodated  to  the  rapidity  of  fever,  when  it 
manifefts  itfeif  in  apoplexy,  palfy,  and  fyncope. 

3.  It  is  under  the  command  of  a  phyfician.  He 
may  bleed  ivhen  and  ivhere  he  pleafes,  and  may 

f^iit 


A,   DEFENCE    OF    BLOOD-LETTING.  221, 

fiiit  the  quantity  of  blood  he  draws,   exaflly  to  the 
condition  of  his  patient's  fyllem. 

4.  It  may  be  performed  v/ith  the  leafl:  attendance 
of  nurfes  or  friends.  This  is  of  great  importance 
to  the  poor  at  all  times,  and  to  the  rich  during  the. 
prevalence  of  contagious  and  mortal  epidemics. 

5.  It  diflurbs  the  fydem  much  lefs  than  any  of 
the  other  modes  of  depleting,  and  therefore  is  befl: 
accommodated  to  that  flate  of  the  fyilem,  in  which 
patients  are  in  danger  of  fainting  or  dying  upoa 
being  moved. 

6.  It  is  a  more  delicate  depleting  remedy  than 
mod  of  thofe  which  have  been  mentioned,  particu- 
larly vomits,  purges,  and  a  falivation. 

7.  There  is  no  immediate  danger  to  life  from  \i% 
ufe.  Patients  have  fometimes  died  under  the  opera- 
tion of  vomits  and  purges,  but  I  never  faw  nor 
heard  an  inilance  of  a  patient's  dying  in  a  fainty  fit,, 
broucrht  on  by  bleedinq-. 

8.  It  is  lefs  weakening,  when  ufcd  to  the  extent 
that  is  neceilary  to  cure,  than  the  fame  degrees  of 
vomiting,  purging,  and  fweating. 

9.  Con- 


222  A    DEFENCE    OF    BLOOD-LETTING. 

9.  Convalefcence  is  more  rapid  and  more  perfecl 
after  bleeding,  than  after  the  fuccefsful  ufe  of  any  of 
the  other  evacuating  remedies. 

By  making  ufe  of  blood-letting  in  fevers,  we  are 
not  precluded  from  the  benefits  of  the  other  evacua- 
ting remedies.  Some  of  them  are  rendered  more 
certain  and  more  effe^lual  by  it,  and  there  are  cafes 
of  fever,  in  which  the  combined  or  fucceifive  appKca- 
of  them  all,  is  barely  fufficient  to  fave  life. 

To  rely  upon  anv  one  evacuating  remedy,  to  the 
exclufion  of  the  oihers,  is  like  trufting  to  a  p?vir  of 
oars  in  a  fca  voyage,  inilead  of  fpreading  every  fail 
of  a  ill) p. 

I  fufpecl  the  difputes  about  the  eligibility  of  the 
different  remedies  which  have  been  mentioned,  have 
arifen  from  an  ignorance  that  they  all  belong  to  one 
clafs,  and  that  they  differ  only  in  their  force  and 
m.anner  of  operation.  Thus  the  phyficians  of  the 
iail:  century  afcribed  different  virtues  to  falts  of  dif- 
ferent namesp  which  the  chemiffs  of  the  prefent  day 
have  taught  us  are  exa6tly  the  fame,  and  differ  only 
in  the  manner  of  their  being  prepared. 

Having  replied  to  the  principal  ob]e£l:ions  to  blood- 
letting, and  dated  its  comparative  advantages  over 
\  other 


Jk    DEFENCH    OF    BLOOD-LETTING.  223 

Other  modes  ofaepletion,  I  proceed  next  to  mention 
the  circumitances  which  fliould  regulate  the  ufc  of  it. 
Thefe  are, 

I.  The  ftate  of  the  pulse. 

The  following  ftates  of  the  pulfe  indicate  the  nc*- 
ceiTity  of  bleeding. 

1.  A  full,  frequent,  and  tenfe  pulfe,  fuch  as  oc- 
curs in  the  pulmonary,  rheumatic,  gouty,  phrenitic, 
and  maniacal  flates  of  fever. 

2.  A  full,  frequent,  and  jerking  pulfe,  without 
tenfion,  fuch  as  frequently  occurs  in  the  vertiginous, 
^paralytic,  apopleftic,  and  hydropic  ftates  of  fever. 

3.  A  fmall,  fi'equent,  but  tenfe  pulfe,  fuch  as  oc- 
'Curs  in  the  chronic,  pulmonary,  and  rheumatic  fiates 
of  fever. 

4.  A  tenfe  and  qukk  pulfe,  without  much  preter- 
•natural  frequency.  This  Hate  of  the  pulfe  is  com- 
mon in  the  yellow  fever. 

5.  A  flow  but  tenfe  pulfe,  fuch  as  occurs  in  the 
apopleflic,  hydrocephalic,  and  malignant  flates  of 
fever,  in  which  its  (Irokes  are  from  60,  to  9,  in  a 
minute. 

6.  An 


224  ^    DEFENCE    OF    BLOOD-LETTING. 

6.  An  uncommonly  frequent  pulfe,  without  much 
tenfion,  beating  from  120  to  170  or  r8o  flrokes  in 
a  minute.  This  ftate  of  the  pulfe  occurs  likewifc  m 
the  malignant  flates  of  fever. 

7.  A  foft  pulfe,  without  much  frequency  or  ful- 
nefs.  I  have  met  with  this  ftate  of  the  pulfe  in  af- 
fections of  the  brain,  and  in  that  fl:ate  of  pulmo- 
nary fever  wliich  is  known  by  the  name  of  pneu- 
monia notha.  It  fometimes,  I  have  remarkedj  be- 
comes tenfe  after  bleeding. 

8.  An  intermitting  pulfe. 

9.  A  depreifed  pulfe. 

10.  An  im.perceptible  pulfe.  The  flow,  inter- 
mitting, depreifed,  and  imperceptible  flates  of  the 
pulfe,  are  fuppofed  exclufively  to  indicate  congeftion 
in  the  brain.  But  they  are  all,  I  believe,  occa- 
fioned  likewife  by  great  excefs  of  ftimulus  a£l:ing 
upon  the  heart  and  arteries.  A  pulfe  more  tenfe  in 
one  arm  than  in  the  other,  I  have  generally  found 
to  attend  a  morbid  ft  ate  of  the  brain.  Much  yet 
remains  to  be  known  of  the  figns  of  a  difeafe  in  th^ 
brain,  by  the  fcates  of  the  pulfe  ;  hence  Mr.  Hun- 
ter has  jullly  rem^arked,  that  "  In  infiam.mation  of 
the  brain,  the  pulfe  varies  more  than  in  infiamma- 

2  tions 


A    DEFENCE    OF    BLOOD-LETTING.  ^2^ 

tions  of  any  other  part ;  and  perhaps  we  are  led  to 
judge  of  inflammation  there,  more  from  otbcr  fymp- 
toms  than  the  pulfe."  * 

The  flow,  uncommonly  frequent,  intermitting, 
and  imperceptible  ftates  of  the  pulfe  which  require 
bleeding,  may  be  difl:inguiflied  from  the  fame  fl:ates 
of  the  pulfe,  which  arife  from  direct  debility  or  an 
exhaufl:ed  fl:ate  of  the  fyfl:em,  and  that  forbid  bleed- 
ing by  the  following  marks. 

1.  They  occur  in  the  beginning  of  a  fever. 

2.  They  occur  in  the  paroxyfms  of  fevers  which 
have  remiflions  and  exacerbations. 

3.  They  fometimes  occur  after  blood-letting, 
from  caufes  formerly  mentioned. 

4.  They  fometimes  occur,  and  continue  during 
the  whole  courfe  of  an  inflammation  of  the  fl:omach 
and  bowels.     And, 

5.  They  occur  in  relapfes,  after  the  criCs  of  a 
fever. 

The  other  fl:ates  of  the  pulfe  indicate  bleeding  in 
every  fl:age  of  fever,  and  in  every  condition  of  the 

*  Chap.  ill.  9. 

p  fyftem. 


^iS  A    DEFENCE    OF    BLOOD-LETTINQ^ 

iyjftem.  I  have  taken  notice,  in  another  place,  of 
the  circumftances  which  render  it  proper  in  the  ad- 
vanced  ftage  of  chronic  fever. 

If  all  the  ftates  of  pulfe  which  have  been  enume* 
rated,  indicate  bleeding,  it  mufl  be  an  affe£Hng 
Gonfideration  to  refle<fi:^  how  many  lives  have  been 
lofl  by  phyfieians  limiting  the  lafe  of  the  lancet  only 
to  the  tenfe  or  full  pulfe  ! 

I  wifli  it  comported  with  the  propofed  limits  of 
this  efTay  to  illuftrate  and  eftablifli,  by  the  recital  of 
cafes,  the  truth  of  thefe  remarks  upon  the  indica- 
tions of  bleeding  from  the  pulfe.  It  is  the  trueft 
index  of  the  flate  of  the  fyflem,  and  when  it  is  per- 
fectly underflood,  it  never  deceives.  Its  frequency,, 
(unconne£]:ed  with  its  other  Hates),  being  under  the 
influence  of  diet,  motion,  and  the  pailions  of  the 
mind,  is  of  the  leafl  confequence.  In  counting  the 
number  of  its  ftrokes,  we  are  apt  to  be  diverted 
from  attending  to  its  irregularity  and  force  ;  and  in 
thefe,  it  fliould  always  be  remembered,  fever  chiefly 
confiils.  The  knowledge  acquired  by  attending  ta 
thefe  fl:ates  of  the  pulfe  is  fo  definite  and  ufeful^ 
and  the  circumftances  which  feduce  from  a  due  at- 
tention to  them  are  fo  erroneous  in  their  indications', 
that  I  have  fometimes  wiflied  the  Chinefe  cufl:om  of 
prefcribing,  from  feeling  the  pulfe  only,  without 

feeing 


A    DEFENCE    OF    BLOOD-LETTING.  fi^y 

feeing  or  converfing  with  the  patient,  were  impofed 
upon  all  phyficians. 

To  render  the  knowledge  of  the  indications  of 
blood-letting  from  the  ftate  of  the  pulfe  as  definite 
and  correct  as  poflible,  I  fliall  add,  for  the  benefit 
of  young  practitioners,  the  following  dire(flions  for 
feeling  it. 

1.  Let  the  arm  be  placed  in  a  fituation  in  which 
all  the  mufcles  which  move  it  fhall  be  completely 
relaxed  ;  and  let  it,  at  the  fame  time,  be  free  fron^ 
the  prefiTure  of  the  body  upon  it. 

2.  Feel  the  pulfe  in  all  obfcure  or  difficult  cafes, 
in  both  arms. 

3.  Apply  all  the  fingers  of  one  hand,  when  prac* 
ticable,  to  the  pulfe.  For  this  purpofe  it  will  be 
mofl  convenient  to  feel  the  pulfe  of  the  right  hand 
with  your  left,  and  of  the  left  hand  with  your  right* 

4.  Do  not  decide  upon  blood-letting  in  difficult 
cafes,  until  you  have  felt  the  pulfe  for  fome  time. 
The  Chinefe  phyficians  never  prefcribe  until  they 
have  counted  49  flrokes. 

5.  Feel  the  pulfe  at  the  intervals  of  four  or  five 
minutes,  when  you  fufpeft  that  its  force  has  been 

p  2  varied 


228  A    DEFENCE    OF    BLOOD-LETTINd. 

varied  by  any  circumflance  not  connected  with  the 
difeafe,  fuch  as  emotions  of  the  mind,  exercife,  eat- 
ing, drinking,  and  the  hke. 

6.  Feel  the  pulfations  of  the  arteries  in  the  tem- 
ples and  in  the  neck,  when  the  pulfe  is  deprefTed  or 
imperceptible  in  the  wrifls. 

7.  Requefl  filence  in  a  fick  room,  and  clofe 
your  eyes  in  feeling  a  pulfe  in  difficult  cafes.  By 
fo  doing,  you  will  concentrate  the  fenfations  of  your 
ears  and  eyes,  in  your  fingers. 

In  judging  of  the  ftates  of  the  pulfe  which  have 
been  enumerated,  it  will  be  neceffary  always  to  re- 
member the  natural  difference  in  its  frequency  and 
force  in  old  people  and  children  ;  alfo  in  the  morn- 
ing arid  evening,  and  in  the  fleeping  and  waking 
ftates  of  the  fyflem. 

But  to  return. 

11.  Regard  fliouid  be  had  to  the  charafter  of  the 
reigning  epidemic,  in  deciding  upon  blood-letting. 
If  the  prevailing  fever  be  of  a  highly  inflammatory 
nature,  bleeding  may  be  ufed  with  more  fafety  in 
cafes  where  the  indications  of  it  from  the  pulfe  arc 
ibmewhat  doubtful.  The  character  of  a  previous 
epidemic  flaould  likewife  dire^l  the  ufe  of  the  lancet* 

The 


A    DEFENCE    OF    BLOOD-LETTING.  229 

The  peftilential  fever  which  followed  the  plague  in 
London  in  1665,  Dr.  Sydenham  fays,  yielded  only 
to  blood-letting.  It  is  equally  neceffary  in  all  the 
febrile  difeafes  which  fucceed  malignant  fevers. 

III.  The  conflitution  of  a  patient,  and  more  efpe- 
cially  his  habits  with  refpe£l:  to  blood-letting,  fliould 
be  taken  into  conlideration,  in  prefcribing  it.  If  he 
be  plethoric,  and  accuflomed  to  bleeding  in  former 
indifpolitions,  it  will  be  more  neceifary  than  in  op*- 
polite  ilates  and  habits  of  the  fyflem. 

IV.  Regard  fliould  be  had  to  the  country  or  place 
from  which  perfons  affe^led  with  fevers  have  lately 
arrived,  in  prefcribing  the  lofs  of  blood.  Fevers 
in  America  are  more  inflammatory  than  fevers  in 
perfons  of  equal  rank  in  Great  Britain.  From  a 
want  of  attention  to  this  circumftance,  I  faw  a  com- 
mon pleurify  end  in  an  abfcefs  in  the  lungs,  in  a 
fea-captain  in  the  city  of  London,  in  the  year  1769, 
who  was  attended  by  a  phyflcian  of  the  firil  repu^ 
tation  in  England.  He  was  bled  but  once.  His 
cure  was  afterwards  trufted  to  fudorific  draughts^ 
His  pulfe  and  his  American  confliitution  indicated 
the  lofs  of  50  or  60  ounces  of  blood. 

V.  After  blood-letting  has  been  performed,  the 
appearances  of   the  blood  fliould  be  attended  to^, 

P3  m 


^3«  A    DEFEKCE    O?   BLOOD-LETTING. 

in  order  to  judge  of  the  propriety  of  repeating  it, 
I  fliall  briefly  defcribe  thefe  appearances,  and  ar- 
range them  in   the  order  in   which   they  ind.icatc 
the  diiFerent  degrees  of  inflammatory  diathefis,  be-^ 
ginning  with  the  higheft. 

I.  Diffolved  blood.  It  occurs  in  the  malignant 
ftates  of  fever.  I  have  feen  it  feveral  times  in 
the  pleurify,  and  have  once  heard  of  it  in  a  cafe  of 
gout.  I  have  afcribed  this  decompofition  of  the 
blood  to  fuch  a  violent  degree  of  flimulus  upon 
the  blood- velTels,  as  to  difpofe  them  to  a  paralytic 
flate.  It  is  generally  confidered  as  a  fignal  to  lay 
afide  the  lancet.  If  it  occur  in  the  firft  ftage  of 
a  fever,  it  indicates  a  very  oppolite  pra^lice.  By 
repeated  bleedings,  the  veffels  recover  their  natu- 
ral adlion,  and  the  blood  becomes  reduced  to  its 
original  texture.  Of  this  I  have  had  frequent  ex- 
perience fince  the  year  1793.  It  required  three 
fuccefTive  bleedings  to  reftore  the  blood  from  a 
diffolved  to  a  coag[ulable  ftate  in  Mr.  Benton.  It 
afterwards  became  very  fizy.  If  this  diffolved  blood 
appear  towards  the  clofe  of  a  malignant  fever,  no 
other  benefit  than  the  protra6lion  of  life  for  a  day 
or  two,  or  an  eafy  death,  can  be  expelled  from 
repeating  the  bleeding,  even  though  it  be  indicated 
by  a  tenfe  pulfe ;  for  the  vifcera  are  generally  fo 
-much  choaked  by  the  continuance  of  violent  a<5lion 

in 


a  t)SF£N€E   OF-^IrOOD-LETTINO.  i^l 

In  the  biood-veffels,  that  they  are  feldom  abk  to 
difcharge  the  blood  which  diflends  them,  into  the 
cavity  in  the  vefTels  which  is  created  by  the  ab- 
ftra<^ion  of  blood  from  a  vein.  There  is  fome 
variety  in  the  appearance  of  this  flate  of  the  blood, 
\vhich  indicates  more  or  lefs  violent  preffure  upon 
the  blood-veiTels.  It  threatens  mofl  danger  to  life 
when  it  refembles  molaifes  in  its  confidence.  The 
danger  is  lefs  when  the  part  which  is  difTolved 
occupies  the  bottom  of  the  bowl,  and  when  its 
furface  is  covered  with  a  fizy  pellicle  or  coat. 

Does  not  the  reftoration  of  the  blood  from  its  dif- 
organized  flate,  by  means  of  bleeding,  fuggefl  aa 
4dea  of  a  fmiilar  change  being  pradicable  in  the  fo- 
iids,  when  they  are  diforganized  by  difeafe  ?  And 
are  we  not  led  hereby  to  an  animating  view  of  the 
/extent  and  power  of  medicine  ? 

2.  Blood  of  a  fcarlet  colour,  without  any  fepara- 
tion  into  craiTamentum  or  ferum,  indicates  a  fecond 
"degree  of  inflammatory  action.  It  occurs  Kkewife 
in  the  malignant  flate  of  fever. 

3.  Blood  in  which  part  of  the  craiTamentum  is 
dilTolved  in  the  ferum.,  forming  a  refemblance  to 
what  is  called  the  lotura  carnium,  or  the  wafliings 
-vif  Befli  in  water. 

p  4  4.  Craf- 


332  A   DEFENCE    OF   BLOOD-LETTlNG* 

4.  CrafTamentum  finking  to  the  bottom  of  a  bowl 
in  yellow  ferum. 

5.  Craflamentum  floating  in  ferum  which  is  at 
firfl  turbid,  but  which  afterwards  becomes  yellow 
and  tranfparent  by  depofiting  certain  red  and  fiery 
particles  of  the  blood  in  the  bottom  of  the  bowl. 

6.  Sizy  blood,  or  blood  covered  with  a  bufFy 
coat.  The  more  the  craflamentum  appears  in  the 
form  of  a  cup,  the  more  inflammatory  action  is  faid 
to  be  indicated  by  it.  This  appearance  of  the  blood 
occurs  in  all  the  common  fliates  of  inflammatory 
fever.  It  occurs  too  in  the  mild  fl:ate  of  malignant 
fevers,  and  in  the  clofe  of  fuch  of  them  as  have 
been  violent.  It  is  not  always  connected  with  the 
common  inflammatory  fl:ate  of  the  pulfe,  for  I  have 
obferved  it  occaflonally  in  mofl:  of  the  different  fliates 
of  the  pulfe  which  have  been  defcribed.  The  ap- 
pearance of  this  bufly  coat  on  the  blood  in  the  yel- 
low fever,  is  always  favourable.  It  fliews  the  dif- 
eafe  to  be  tending  from  an  uncommon,  to  a  common 
degree  of  inflammatory  diathefls. 

It  would  feem,  from  thefe  fadls,  as  if  the  power 
of  coagulation  in  the  blood  was  lefl^ened  in  an  exa£l: 
ratio  to  the  increafe  of  fliimulus  upon  the  blood- 
veflels,  and  that  it  was  increafed  in  proportion  to 

the 


A    DEFENCE    OF    BLOOD-LETTlKG.  233 

the  diminution  of  that  ftimuhis,  to  that  degree  of 
action  which  conflitutes  what  I  have  called  common 
inflammatory  a£lion. 

Here  as  upon  a  former  occafion  we  may  fay  with 
concern,  if  bleeding  be  indicated  by  all  the  appear- 
ances of  the  blood  which  have  been  enumerated, 
how  many  lives  have  been  lofl  by  phyficians  limiting 
the  ufe  of  the  lancet  to  thofe  cafes  only,  where  the 
blood  difcovered  an  inflammatory  crufl ! 

Thefe  remarks  upon  the  relative  figns  of  inflam- 
matory action  in  the  blood- veflels,  fliould  be  admit- 
ted with  a  recollection  that  they  are  all  liable  to  be 
varied  by  a  moderate,  or  violent  exacerbation  of 
fever,  by  the  fize  of  the  llream  of  blood,  and  by  the 
heat,  coldnefs,  and  form  of  the  cup  into  which  the 
blood  flows.  This  occafional  uncertainty  in  the  in- 
dications of  the  fl:ate  of  fever  by  the  blood,  fliouId 
lead  us  back  to  the  pulse.  When  time,  and  more 
attention  to  this  index  of  the  fl;ate  of  the  fyfl:em  in 
fevers,  fliall  have  brought  to  light  all  the  knowledge 
that  the  pulfe  is  capable  of  imparting,  the  ap- 
pearances of  the  blood  in  fevers,  will  be  regarded 
as  little  as  the  appearances  of  the  urine. 

'  VI.  Blood-letting  fliould  always  be  copious  where 
there  is  danger  from  congeftion  or  inflammation, 

in 


234  A    DEFENCE    OF    BLOOD-LETTING, 

iQ  vital  parts.  This  danger  is  indicated  moft  com-j 
monly  by  pain  ;  but  there  may  be  congeflion  in  the 
liver,  bowels,  and  even  in  the  head,  without  pain. 
In  thefe  cafes,  the  ftate  of  the  pulfe  fliould  alv/ays 
govern  the  ufe  of  the  lancet. 

VIL  What  quantity  of  blood  may  be  taken,  with 
fafety,  from  a  patient  in  an  inflammatory  fever  ?  To 
anfwer  this  queflion  it  v/ill  be  neceflary  to  remark, 
I.  That  in  a  perfon  of  an  ordinary  fize,  there  are 
fuppofed  to  be  contained  between  25  and  28  pounds 
of  blood,  and  2.  That  much  more  blood  may  be 
taken  v/hen  the  blood- veflels  are  in  a  ftate  of  morbid 
excitement  and  excitability,  than  at  any  other  time. 
One  of  the  ufes  of  the  blood  is  to  flimulate  the 
blood-veflels,  and  thereby  to  aiTifl  in  originating, 
and  preferving  animal  Hfe,  In  a  healthy  ftate  of 
the  vefTels,  the  whole  mafs  of  the  blood  is  neceiTary 
for  this  purpofe  ;  but  in  their  flate  of  morbid  ex- 
citability, a  much  lefs  quantity  of  blood  than  what 
h  natural,  (perhaps  in  fome  cafes  four  or  five 
pounds)  are  fiifficient  to  keep  up  an  equal  and 
vigorous  circulation.  Thus  very  fmall  portions  of 
light,  and  found,  are  fufficient  to  excite  vifion  and 
hearing  in  an  inflamed,  and  highly  excitable  flate 
of  the  eyes  and  ears.  Thus  too,  a  fmgle  glafs  of 
wine  v/ill  often  produce  delirium  in  a  fever  in  a 
man,  v/ho,  when  iiiJiealth,  is  in  the  habit  of  drinking 

a  bottle 


A   DEFENCE    OF    BLOOD-LETTING.  235 

a  bottle  every  day  without  having  his  pulfe  quick- 
ened by  it. 

An  ignorance  of  the  quantity  of  blood  which  has 
been  drawn  by  defign,  or  lofl  by  accident,  has  con- 
tributed very  much  to  encourage  prejudices  againfl 
blood-letting.  Mr.  Cline  drew  320  ounces  of  blood 
in  20  days  from  a  patient  in  St.  Thomas's  hofpital, 
who  laboured  under  a  contufion  of  the  head.  But 
this  quantity  is  fmall  compared  with  the  quantity 
lofl  by  a  number  of  perfons  whofe  cafes  are  recorded 
by  Dr.  Haller.*  I  fliall  mention  a  few  of  them. 
One  perfon  lofl  9  pounds  of  blood,  a  fecond  12, 
a  third  18,  and  a  fourth  22,  from  the  nofe  at 
one  time.  A  fifth  lofl  12  pounds  by  vomiting 
in  one  night,  and  a  fixth  22  from  the  lungs.  A 
gentleman  at  Angola  loft  between  3  and  4  pounds 
daily  from  his  nofe.  To  cure  it  he  was  bled  97 
times  in  one  year.  A  young  woman  was  bled  1020 
times  in  19  years,  to  cure  her  of  plethora  which 
difpofed  her  to  hyfleria.  Another  young  woman  lofl 
125  ounces  of  blood  by  a  natural  haemorrhage  every 
month.  To  cure  it,  flie  was  bled  every  day,  and 
^very  other  day  for  14  months.  In  none  ofthefe 
inflances,  was  death  the  confequence  of  thefe  great 
evacuations  of  blood.    On  the  contrary,  all  the  per- 

"^  Elementa  Phyfiolog'ge,  vol.  iv.  p.  45. 

fons 


fej^  A    DEFENCE    OF    BLOOD-LETTING. 

fens  alluded  to,  recovered.  Many  fimllar  inflances 
of  the  fafety,  and  even  benefit  of  profnfe  difcharges 
of  blood  by  nature  and  art,  might  be  mentioned 
from  other  authors.  I  ihall  infert  only  one  more, 
which  ihall  be  taken  from  Dr.  Sydenham's  account 
of  the  cure  of  the  plague.  "  Among  the  other 
calamities  of  the  civil  war  which  afflifled  this  nation, 
the  plague  alfo  raged  in  feveral  places,  and  was 
brought  by  accident  from  another  place  to  Dunftar 
Callle  in  Somerfetfliire,  where  fome  of  the  foldiers 
dying  fuddenly,  with  an  eruption  of  fpots,  it  like- 
wife  feized  feveral  others.  It  happened  at  that  time 
that  a  furgeon  who  had  travelled  much  in  foreign 
parts,  was  in  the  fervice  there,  and  applied  to  the 
governor  for  leave  to  alTifl  his  fellow  foldiers  who 
were  affli^led  with  this  dreadful  difeafe  in  the  beft 
manner  he  was  able  ;  which  being  granted,  he  took 
fo  large  a  quantity  of  blood  from  ev<ery  one  at  the 
beginning  of  the  difeafe,  and  before  any  fwelling 
was  perceived,  that  they  were  ready  to  faint,  and 
drop  dov/n,  for  he  bled  them  all  ftanding,  and  in 
the  open  air  and  had  no  veiTel  to  meafure  the  blood, 
wiiich  falling  on  the  ground,  the  quantity  each  per- 
•ionlofl,  could  not  of  courfe  be  known.  The  opera- 
tion being  over,  he  ordered  them  to  He  in  their 
tents ;  iind  though  he  gave  no  kind  of  remedy  after 
bleeding,  yet  of  the  numbers  that  were  thus  treated, 
)iot  a  iii>gle  perfon  died.     I  had  this  relation  from 

colonel 


A    DEFENCE    OF    BLOOD-LETTING. 


'^-n 


€olonel  Francis  Windham  a  gentleman,  of  great 
honor,  and  veracity,  and  at  this  time  governor  of 
theCaflle."* 

Again.  An  ignorance  of  the  rapid  manner  in 
which  blood  is  regenerated  when  loll  or  drawn,  has 
helped  to  keep  up  prejudices  againfl  blood-letting. 
A  perfon  (Dr.  Haller  fays)  lofl  live  pounds  of  blood 
daily  from  the  h^emorrhoidal  veffels  for  62  days^ 
and  another  ']^  pounds  of  blood  in  10  days.  The 
lofs  each  day  was  fupplied  by  frefli  quantities  of 
ahment. 

Thefe  fafts  I  hope,  will  be-  fufEcient  to  e{labli& 
the  fafety  and  advantages  of  plentiful  blood-letting 
in  cafes  of  violent  fever  ;  alfo  to  fhew  the  fallacy 
and  danger  of  that  practice  which  attempts  the  cure 
of  fuch  cafes  of  fever,  by  what  is  called  moderate 
bleeding.  There  are,  it  has  been  faid,  no  half 
truths  in  goveiTiment.  It  is  equally  true,  that  there 
are  no  half  truths  in  medicine.  This  half-way  prac- 
tice of  moderate  bleeding,  has  kept  up  the  mortality 
of  peftilential  fevers  in  all  ages,  and  in  all  coun- 
tries. 

I  have  combated  this  pradiice  elfewhere,  t  and 
have  alTerted,  upon  the  authority  of  Dr.   Syden- 

*  Vol.  I.  p.  131.      f  Account  of  the  Yellow  Fever,  in  1793. 

ham. 


238  A    DEFENCE   O^  BLOOD-jLETTlNG. 

ham,  that  it  is  much  better  not  to  bleed  at  all,  than 
to  draw  blood  difproportioned  in  quantity  to  the 
violence  of  the  fever.  If  the  flate  of  the  pulfe  be 
our  guide,  the  continuance  of  its  inflammatory  aflion, 
after  the  lofs  of  even  an  100  ounces  of  blood,  in- 
dicates the  neceffity  of  more  bleeding,  as  much  as 
it  did  the  firfk  time  a  vein  was  opened.  In  the 
ufe  of  this  remedy  it  may  be  truly  faid,  as  in  many- 
of  the  enterprizes  of  life,  that  nothing  is  done,  while 
any  thing  remains  to  be  done.  Bleeding  fhould  be 
repeated  while  the  fymptoms  which  at  firfl  indicated 
it  continue,  fliould  it  be  until  four-fifths  of  the  blood 
contained  in  the  body  are  drawn  away.  In  this 
manner  we  aft  in  the  ufe  of  other  remedies.  Who 
ever  leaves  off  giving  purges  in  a  colic,  attended 
with  coftivenefs,  before  the  bowels  are  opened?  or 
who  lays  afide  mercury  as  a  ufelefs  medicine,  becaufe 
a  few  dofes  of  it  do  not  cure  the  venereal  difeafe  ? 

I  fliall  only  add  under  this  head,  that  I  have 
always  obferved  the  cure  of  a  malignant  fever  to  be 
moft  complete,  and  the  convalefcence  to  be  mofl 
rapid,  when  the  bleeding  has  been  continued  until 
a  paknefs  is  induced  in  the  face,  and  until  the  patient 
is  able  to  fit  up  without  being  fainty.  After  thefe 
circumftances  occur,  a  moderate  degree  of  force  in 
the  pulfe  will  gradually  wear  itfelf  away  without 
doing  any  harm, 

VIII.  In 


^  DEFENCE 'OF    BLOOD-LETTING-.  239 

,-  VIII.  In  drawing  blood,  the  quantity  fliould  bq 
large  or  fmall  at  a  time,  according  to  the  flate  of 
the  fyftem.  In  cafes  where  the  pulfe  ^£ts  with  force 
and  freedom,  from  lo  to  20  ounces  of  blood  may 
be  taken  at  once ;  but  in  cafes  of  great  indire^l  de- 
bihty,  where  the  pulfe  is  deprelTed,  it  will  be  bet- 
ter to  take  away  but  a  few  ounces  at  a  time,  and  to 
repeat  it  three  or  four  times  a-day.  By  this  means^ 
the  blcod-veifels  more  gradually  recover  their  vigour, 
and  the  apparent  bad  elFe^ls  of  bleeding  are  thereby 
prevented.  Perhaps  the  fame  advantages  might  be 
derived  in  many  other  cafes  from  the  gradual  ab- 
Itraftion  of  ftimuli,  that  are  derived  from  the  gra- 
dual increafe  of  their  force  and  number,  in  their  ap- 
plication to  the  body.  In  an  inflammatory  fever,  the 
charadler  of  which  is  not  accurately  known,  it  is 
fafefl:  to  begin  with  moderate  bleeding,  and  to  in- 
creafe it  in  quantity,  according  as  the  violence  and 
duration  of  the  difeafe  ihall  make  it  neceffary.  Iii 
fevers  and  other  difeafes  which  run  their  courfes  in  a 
few  days  or  hours,  and  which  threaten  immediate 
diifolution,  there  can  be  no  limits  fixed  to  the  quan^ 
tity  of  blood  which  may  be  drawn  at  once,  or  in  a 
fliort  time.  Botallus  drew  3,4,  and  5  pints  in  a 
day  in  fuch  cafes.  Dr.  Phyfick  drew  90  ounces  by 
weight  from  Dr.  Dewee?,  in  a  fudden  attack  of  the 
apoplectic  (late  of  fever ^^  at  one  bleeding,  and  there- 


240  A    DEFENCE    OF    BLOOD-LETTING. 

by  reftored  him  fo  fpeedily  to  health,  that  he  was 
able  to  attend  to  his  bufmefs  in  three  days  afterwards- 
In  chronic  flates  of  fever,  of  an  inflammatory  type, 
fmall  and  frequent  bleedings  are  to  be  preferred  to 
large  ones.  We  ufe  mercury,  antimony,  and  diet 
drinks  as  alteratives  in  many  difeafes  with  advan- 
tage. We  do  not  expert  to  cure  certain  difeafes  of 
debility  by  two  or  three  immerfions  in  a  cold  bath. 
We  perfifl  with  patience  in  prefcribing  all  the  above 
remedies  for  months  and  years,  before  we  expe£l  to 
reap  the  full  benefits  of  them.  Why  fhould  not 
blood-letting  be  ufed  in  the  fame  way,  and  have  the 
lame  chance  of  doing  good.  I  have  long  ago  adopted 
this  alterative  mode  of  ufing  it,  and  I  can  now  look 
around  me,  and  with  pleafure  behold  a  number  of 
perfons  of  both  fexes  who  owe  their  lives  to  it.  In 
many  cafes  I  have  prefcribed  it  once  in  two  or  three 
months  for  feveral  years ;  and  in  fome  I  have  ad- 
vifed  it  every  two  weeks,  for  feveral  months. 

There  is  a  ilate  of  fever  in  which  an  excefs  in  the 
a^lion  of  the  blood-veifels  is  barely  perceptible,  but 
which  often  threatens  immediate  danger  to  life,  by 
a  determination  of  blood  to  a  vital  part.  In  this 
cafe,  I  have  frequently  feen  the  fcale  turn  in  favour 
of  life,  by  the  lofs  of  but  four  or  ^yc  ounces  of 
blood.  The  preffure  of  this,  and  even  of  a  much 
4  lefs 


A    DEFENCE    OF    BLOOD-LETTING.  ^^t 

lefs  quantity  of  blood  in  the  clofe  of  a  fever,  I  be- 
lieve as  effedtually  deflroys  life,  as  the  excefs  of 
feveral  pounds  does  in  its  beginnings 

In  cafes  where  bleeding  does  not  cure,  it  may  be 
ufed  with  advaiitage  as  d.  palliative  remedy.  Many 
difeafes  induce  death  in  a  full  and  highly  excited 
flate  of  the  fyflem.  Here  opium  does  harm,  while 
bleeding  aiFords  certain  relief.  It  belongs  to  this 
remedy,  in  fuch  cafes,  to  eafe  pain,  to  prevent  con- 
vulfions,  to  compofe  the  mind,  to  protract  the  ufe  of 
reafon,  to  induce  fleep,  and  thus  to  fmooth  the  paf« 
fage  out  of  life. 

IX.  Bleeding  from  an  artery,  commonly  called 
arteriotomy,  would  probably  have  many  advantages 
over  venefe^lion,  could  it  be  performed  at  all  times 
with  eafe  and  fafety.  Blood  difcharged  by  hemor- 
rhages affords  more  relief  in  fevers  than  an  equal 
quantity  drawn  from  a  vein,  chiefly  becaufe  it  is 
poured  forth  in  the  former  cafe  from  a  ruptured 
artery.  I  mentioned  formerly,  that  Dr.  Mitchell  had 
found  blood  drawn  from  an  artery  to  be  what  is 
called  denfe,  at  a  time  when  that  v/hich  was  drawn 
from  a  vein  in  the  fame  perfons,  was  diifolved. 
This  fa(5l  may  poflibly  admit  of  fome  application.  In 
the  clofe  of  malignant  fevers,  where  bleeding  ha-s 
been  omitted  in  the  beginning  of  the  diforder,  blood 

c^  drawn 


343  A    DEFENCE    OF   BLOOD-LETTING, 

drawn  from  a  vein  is  generally  fo  diffolved,  as  to  be 
t)eyond  the  reach  of  repeated  bleedings  to  reftore  it 
to  its  natural  texture.  In  this  cafe,  arteriotomy 
might  probably  be  performed  with  advantage.  The 
arteries,  which  retain  their  capacity  of  life  longer 
than  the  veins,  by  being  relieved  from  the  imme- 
diate preffure  of  blood  upon  them,  might  be  en- 
abled fo  to  a£l  upon  the  torpid  veins,  as  to  reftore 
their  natural  a^ion,  and  thereby  to  arreft  departing 
life*  Arteriotomy  might  further  be  ufed  with  ad- 
vantage in  children,  in  whom  it  is  difficult,  and 
fometimes  impra£licable  to  open  a  vein. 

X.  Much  has  been  faid  about  the  proper  place 
from  whence  blood  ftiould  be  drawn.     Bleeding  in 
the  foot  was  much  ufed  formerly,  in  order  to  e^c- 
cite  a  revulfion  from  the  head  and  breaft ;  but  our 
prefent  ideas  of  the  circulation  of  the  blood  have 
taught  us,  that  it  may  be  drawn  from  the  arm  with 
equal  advantage  in  nearly  all  cafes.     To  bleeding  in 
the  foot  there  are  the  following  objeftions :  i.  The 
difficulty  of  placing  a  patient  in  a  fituation  favour- 
able to  it.    .2.  The  greater  danger  pf  wounding  a 
tendon  in  the  foot  than  in  the  arm.     And,  3.  The 
impoffibility  of   examining   the  blood   after   it  is 
drawn ;   for  in  this  mode    of  bleeding,  the  blQpd 
generally  flow$  into  a  bafon  or  pail  of  water. 

Under 


A    DEFENCE    OF    BLOOD-JLETTING.  243 

Under  this  head  I  fliall  decide  upon  the  method 
of  drawing  blood  by  means  of  cups,  in  the  inflam^ 
matory  flate  of  fever.  Where  an  Inflammatory  fever 
arlfes  from  local  affection,  or  from  contufion  in  the 
head  or  breaft,  or  from  a  morbid  excitement  in 
thofe,  above  other  parts  of  the  arterial  fyftem,  they 
may  be  ufeful ;  but  where  local  affection  is  a  fymp- 
tom  of  general  and  equable  fever  only,  it  can  fel- 
dom  be  neceifary,  except  where  bleeding  from  the 
arm  has  been  omitted,  or  ufed  too  fparingly  in  the 
beginning  of  a  fever  ;  by  which  means  fuch  fixed 
congeflion  often  takes  place,  as  will  not  yield  to  ge- 
neral bleeding. 

XL  Much  has  been  faid  likewife  about  the  pro- 
per time  for  bleeding  in  fevers.  It  may  be  ufed 
at  all  times,  when  indicated  by  the  pulfe  and  other 
circumflances,  in  continual  fevers ;  but  it  fliould 
be  ufed  chiefly  in  the  paroxyfms  of  fuch  as  Inter- 
mit. I  have  conceived  this  practice  to  be  of  fo  much 
confequence,  that  when  I  expert  a  return  of  the 
fever  in  the  night,  I  requeft  one  of  my  pupils  to 
fit  up  with  my  patients  all  night,  in  order  to  meet 
the  paroxyfm,  if  neceflary,  with  the  lancet.  But 
I  derive  another  advantage  from  fixing  a  centlnel 
over  a  patient  in  a  malignant  fever.  When  a 
paroxyfm  goes  off  in  the  night,  it  often  leaves  the 
fyflem  in  a   flate  of  fuch  extreme    debility  as  to 

<12  endanger 


^44  A    DEFENCE    OF   BLOOD-lETTIN^. 

endanger  life.  In  this  cafe,  from  5  to  lo  drops 
of  laudanum,  exhibited  by  a  perfon  who  is  a  judge 
of  the  pulfe,  obviate  this  alarming  debility,  and 
often  induce  eafy  and  refrefliing  ileep.  By  treat- 
ing the  human  body  like  a  corded  inftrument,  in 
thus  occafionally  relaxing  or  bracing  the  fyflem, 
according  to  the  excefs  or  deficiency  of  flim.ulus 
in  thofe  hours  in  which  death  mod  frequently  oc- 
curs, I  think  I  have  been  the  means  of  faving 
feveral  valuable  lives, 

I  regret  that  the  limits  I  have  fixed  to  this 
defence  of  blood-letting  will  not  admit  of  my  ap- 
plying the  principles  which  I  have  delivered,  to 
all  the  inflammatory  flates  of  fever.  I  have  ftiewn, 
in  a  former  publication,  the  advantages  of  bleed- 
ing in  the  hydropic  ilate  of  fever.  In  a  future 
effay,  I  hope  to  eflabhfh  its  efficacy  in  the  gouty 
and  maniacal  flates  of  fever.  I  have  faid  that 
madnefs  is  the  efFeft  of  a  chronic  inflammation  in 
the  brain.  Its  remedy,  of  courfe,  fhould  be  fre- 
quent and  copious  blood-letting.  Phyfical  and  mo- 
ral evil  are  fubjeft  to  fimilar  laws.  The  mad- 
fhirt,  and  all  the  common  means  of  coercion  are 
as  improper  fubflitutes  for  bleeding  in  madnefs, 
as  the  whipping-pofl  and  pillory  are  for  foli- 
tary  confinement  and  labour,  in  the  cure  of  vice. 
The  pulfe  fhould  govern  the  ufe  of  the  lancet  in 

this. 


A    DEFENCE    OF    BLOOD-LETTING.  245 

this,  as  well  as  in  all  the  ordinary  dates  of  fever. 
It  is  the  dial-plate  of  the  fyflem.  But  in  the  mif- 
placed  ftates  of  fever,  the  pulfe,  like  folly  in  old 
age,  often  points  at  a  different  mark  from  nature. 
In  all  fuch  cafes,  we  muft  conform  our  practice 
to  that  which  has  been  fuccefsful  in  the  reigning 
epidemic.  A  fmgle  bleeding,  when  indicated  by 
this  circumftance,  often  converts  a  fever  from  a 
fuffocated  or  latent,  to  a  fenfible  flate,  and  thus 
renders  it  a   more  fimpie  and  manageable  difeafe. 

It  is  worthy  of  confideration  here,  how  far  lo- 
cal difeafes,  which  have  been  produced  by  fevers, 
might  be  cured  by  re-exciting  the  fever.  Sir 
William  Jones  fays  the  phyficians  in  Perfia  always 
begin  the  cure  of  the  leprofy  by  blood-letting.  * 
PoiTibly  this  remedy  diiFufes  the  difeafe  through 
the  blood-velTels,  and  thereby  expofes  it  to  be 
more  eafily  a^led  upon  by  other  remedies. 

I  intended  to  have  enlarged  upon  the  good  ef- 
fects of  bleeding  in  feveral  difeafes  which  are  not 
accompanied  with  fever,  but  having  trefpaifed  too 
long  upon  the  reader's  patience,  by  the  minute- 
nefs  of  my  details  upon  this  fubje£i:,  I  fliall  take 
notice  at  prefent  of  its  efficacy  in  but  the  five 
following  morbid  flates  of  the  fyilem. 

*  Afiatic  EfTays. 

<L3  I.  During 


34^  A   DEFENCE   OF   BLOOD-LETTING* 

r.  During  the  period  in  which  the  menfes  ceafe 
to  flow,  there  is  always  a  morbid  fulnefs  and  excite- 
ment in  the  blood-veflels ;  hence  the  head  achs, 
coughs,  droplies,  haemorrhages,  glandular  obftruc- 
tions,  and  cancers,  which  occur  in  that  ftage  of  life. 
They  may  all  be  prevented  by  frequent  and  mode- 
rate blood-letting. 

2.  Pain  is  probably  not  conne^ed  neceffarily  with 
child-bearing.  Many  of  the  other  evils  inflifled 
upon  the  human  race,  in  confequence  of  the  difobe- 
dience  of  our  firil  parents,  have  been  lelTened  or 
eradicated  by  the  ingenuity  of  man.  The  pain  of 
child-bearing  travellers  tell  us,  is  much  leffened 
among  the  Turkifli  women,  by  their  taking  fweet 
oil  f  which  a6i:s  as  a  purge)  during  their  pregnancy. 
DiYtS:  debility,  whether  induced  by  failing  or  long 
and  flow  difeafes,  tends  alike  to  mitigate  the  pains  of 
labour.  Thefe  fa6ls  have  led  me  to  inquire,  whe- 
ther blood-letting  does  not  produce  the  fame  eife61:. 
I  have  often  obferved  labours  to  be  ftiort  and  com- 
paratively cafy,  which  have  fucceeded  a  fever  that 
has  been  cured  by  bleeding.  Upon  my  mentioning 
this  fafi:  to  Dr.  Dewecs,  he  informed  me  that  he 
had  often  bled  when  parturition  was  flow,  and  that 
he  had  always  found  that  he  thereby  both  fliortened 
and  lefl!ened  the  pains  of  labour. 

3.  I  have 


A   DEFENCE    OF   BLOOD-LETTING.  247 

3.  I  have  faid  that  there  is  but  one  remote  caufc 
€f  fever.  Of  courfe  there  can  be  no  effential  dif- 
ference between  the  ftimulus  of  the  faHva  of  a  rabid 
animal,  and  the  flimulus  of  contagion  or  miafmata, 
in  inducing  morbid  actions  in  the  fyflem.  The  heat, 
thirft,  quick  and  tenfe  pulfe,  and  local  efFufions  which 
occur  in  the  hydrophobia,  indicate  it  to  be  a  fpaf- 
modic  ftate  of  fever.  As  there  is  but  one  remote,* 
and  one  proximate  caufe  of  fever,  fo  there  is  but  one 
method  of  curing  it,  and  that  is  by  reducing  morbid 
a^lion  when  it  is  exceffive  by  depletion,  and  after- 
wards removing  debihty  by  tonic  remedies.  I  can 
fee  no  reafon  why  the  hydrophobia  fhould  not  yield 
to  thefe  obvious,  and  univerfal  principles  in  medi* 
cine.  From  its  great  force,  it  is  probable  it  will 
require  the  moil  copious  bleeding,  and  afterwards 
the  mofl  powerful  tonics  to  cure  it  of  any  diforder 
in  the  world. 

4.  In  diflocations  of  bones  which  refifl  both  ikil! 
afid  force,  it  has  been  fuggefted  that  bleeding,  un* 

*  The  exciting  caufe  of  fever,  which  may  be  confidered  as 
forming  an  exception  to  this  fimple  view  of  its  remote  caufe, 
is  nothing  but  a  reinforcement  of  the  remote  caufe,  when  it 
is  too  feeble  to  excite  fever.  It  generally  a<5ls  as  a  ftimulus, 
and  when  it  a«5ls  by  abftradling  a  natural  ftimulus  from  the 
body,  it  throws  fuch  a  balance  of  force  into  the  fcale  of  the 
remote  caufe,  as  to  enable  it  to  induce  feVer, 

CL4  ti! 


348  A    DEFENCE    OF    BLOOD-LETTING, 

til  fainting  is  induced,  would  produce  fuch  a  re* 
laxation  in  the  mufcles  as  to  favour  their  reduction. 
This  principle  was  happily  applied  in  the  winter  of 
1795,  by  Dr.  Phyfick  in  the  Pennfylyania  hofpital, 
in  a  cafe  of  a  diflocated  humerus  of  two  months 
continuance.  The  Doctor  bled  this  patient  until 
he  fainted,  and  then  reduced  his  flioulder  in  lefs 
tlian  a  minute,  with  a  very  fmall  exertion  of  force, 

5.  I  have  elfewhere  fpoken  in  favour  of  blood-let- 
ting in  fome  of  the  difeafes  of  old  age.*  The  palfy, 
apoplexy,  cough,  and  colic,  fo  common  among  old 
ppople,  might,  I  believe  be  prevented  in  many  in- 
flances  by  the  occafional,  but  moderate  ufe  of  thi§ 
remedy, 

Thus  have  I  finiflied  my  defence  of  blood-letting 
as  a  remedy  foi  certain  difeafes.  Let  not  the  reader 
fuppofe  that  I  am  unduly  attached  to  it.  I  have 
little  reafon  to  be  fo,  for  the  dread  of  my  ufmg  it 
Ix}.  every  difeafe,  and  the  falfe  reports  of  my  uiing 
it  in  equal  degrees  in  difeafes  of  oppofite  characters, 
have  deprived  me  probably  of  many  thoufand  pounds 
in  the  courfe  of  my  life.  But  my  predile6i:ion  for 
the  lancet  above  all  other  depleting  remedies,  has 
aSecled  my  happinefs,  much  more  than  my  interefl^ 

*  Medical  Inquhles,  and  Obfervations,  Vol.  II. 

It 


A    DEFENCE    OF    BLOOD-LETTING.  249 

It  has  made  the  duties  of  my  profeflion  (which  would 
otherwife  be  pleafant)   extremely   painful  to  me. 
Often  have  I  been  forced  to  fubmit  my  judgment  to 
the  fears  and  prejudices  of  my  patients,  and  thereby 
to  confume  days   and  weeks  in  curing  a  difeafe, 
which  might  have  been  cured  in  fome  inflances  by 
the  lofs  of  a  few  ounces  of  blood,  in  a  day  or  an 
hour.     Often,  when  the  appearance  of  danger  has 
made  the  prefcription  of  blood-letting  neceiTary  to 
fave  life,  have  I  read  difaffe^lion   to  it  in  dejected 
looks,   or   tears,    and   fometimes  heard  it   in  the 
fcreams  of  a  whole  family.     And  often  have  I  been 
reproached   for  killing   people  by  bleeding,   who 
h3.ve  died,  only  becaufe  they  fubmit  ted  to  the  re- 
medy when  it  was  too  late,  or  becaufe  it  was  too 
fparingly  adminiHered  to  do  them  fervice.    Nor  have 
the  teflimonies  of  whole  families  and  neighbourhoods 
who  have  been  cured  of  malignant  fevers  by  bleed- 
ing, balanced  the  difcredit  of  the  lofs  of  the  few 
p3.tients  in  whom  it  was  thus  improperly  ufed ;  for 
the  recoveries  in  thofe  cafes  have  been  confidered 
as  remarkable,  only  becaufe  the  patients  furvived 
the  frequent  ufe  of  the  lancett 

It  was  In  confequence  of  the  violence  that  blood- 
letting offered  to  the  feelings  of  his  patients,  and  to 
the  practice  of  cotemporary  phyficians,  that  Dr. 

Sydenham 


25©  A   DEFENCE    OF   BLOOD-LEttmC. 

Sydenham  was  forced  to  adopt  fweatlng  ag  ft  fub« 
ftitute  for  bleeding  in  the  plague,  and  to  ufe  it  very 
fparingly  in  the  rheumatifm.  I  have  reafon  to  la- 
ment his  having  accommodated  this  favourite  re- 
medy to  ignorance  or  fear  in  a  fingle  difeafe.  Had 
he  perfifled  in  the  ufe  of  it,  he  would  indeed  hav^ 
^^  blefled  mankind,  and  refeued  me.'* 

We  are  fometimes  told  by  the  terrorifls  in  medi- 
cine, that  the  Indians  cure  their  inflammatory  fevers' 
without  bleeding.  To  relieve  myfelf  from  the  dif- 
trefs  and  obloquy  to  which  my  ufe  of  this  remedy 
cxpofed  me,  I  have  carefully  fought  for,  and  ex- 
amined their  remedies  for  inflammatory  fever  with 
a  flncere  defire  to  adopt  them ;  but  my  inquiries 
have  fatisiied  me,  that  they  are  not  only  wholly 
difproportioncd  to  the  habits  of  civilized  life,  but 
that  they  are  far  lefs  fuccefsful  than  blood-letting 
even  among  themfelves.  With  the  fame  wilh  to 
avoid  a  painful  conflict  with  the  fears  and  prejudices 
of  my  patients,  I  have  preferibed  all  the  remedies 
which  are  (et  down  under  the  firfl:  head  of  the  fyl- 
labus,  as  fubflitutes  for  bleeding,  but  I  aiH  forry 
to  add,  without  efle61:.  However  ufeful  they  may 
b€  as  auxiliaries  to  blood-letting,  they  are  all  feeble 
without  it,  when  ufed  to  cure  a  fever  of  violent  in- 
fiammatorv  a^£i:ioR. 

In 


A    DEFENCE    OF   Bi^OOD-LETTINO.  251 

In  contemplating  the  prejudices  againfl  blood-let- 
ting which  prevail  fo  generally  in  our  country,  I 
have  been  led  to  afcribe  them  to  a  caufe  v^^holly 
political.  Wg  are  defcended  chiefly  from  Great 
Britain,  and  have  been  for  many  years  under  the 
influence  of  Englifli  habits  upon  all  fubjec^s.  Some 
of  thefe  habits,  as  far  as  they  relate  to  government, 
have  been  partly  changed  ;  but  in  drefs,  arts,  manu- 
factures, manners,  and  fcience,  we  are  ftill  governed 
by  our  early  aflbciations.  Britain  and  France  have 
been  for  many  centuries  hereditary  enemies.  The 
hoftility  of  the  former  to  the  latter  nation,  extends 
to  every  thing  that  belongs  to  their  chara£i:er.  It 
difcovers  itfelf,  in  an  eminent  degree,  in  diet  and 
medicine.  Do  the  French  love  foups  ?  the  Englifli 
prefer  folid  flefli.  Do  the  French  love  their  meats 
well  cooked  ?  the  Englifli  prefer  their  meats  but 
half  roafl:ed.  Do  the  French  flp  coffee  after  dinner? 
the  Englifli  fpend  their  afternoons  in  drinking  Port 
and  Madeira  wines.  Do  the  French  phyficians  pre* 
fcribe  purges  and  glyflcrs  to  cleanfe  the  bowels  ? 
the  Englifli  phyficians  prefcribe  vomits  for  the  fame 
purpofe.  Above  all,  do  the  French  phyficians  ad- 
vife  bleeding  in  fevers  ?  the  Englifli  phyficians  forbid 
it,  in  mofl:  fevers,  and  fubflitute  fweating  in  the 
room  of  it.  Here  then  we  difcover  the  fource  of 
the  prejudices  and  errors  of  our  countrymen,  upon 
the  fubjedl  of  blood-letting.     They  are  of  Britifli 

origin. 


2^2  A    DEFENCE    OF    BLOOD-LETTINGr 

origin.  They  have  been  inculcated  upon  us  in 
Britifh  univerfities,  and  in  Britifli  books  ;  and  they 
accord,  as  illy  with  our  climate,  and  flate  of  fociety, 
ss  the  Dutch  foot  floves  did,  with  the  temperate  cli- 
mate of  the  Cape  of  Good  Hope.* 

It  Is  probable  the  bad  confequences  which  have 
followed  the  indifcrimate,  ufe  of  the  lancet  in 
France,  and  fome  other  countries,  may  have  con- 
tributed in  fome  degree  to  create  the  prejudices 
againfl  it,  which  are  entertained  by  the  phyficians  in 
Great  Britain.     Bleeding  like  opium  has  lofl  its  cha- 

*  I  have  frequently  been  furprized  in  vifitlng  Englif^ 
patients,  to  hear  them  fay,  when  I  have  prefcrlbed  bleeding, 
that  their  phyficians  in  England,  had  charged  them  never  to 
he  bled.  This  advice  excluded  all  regard  to  the  changes 
which  climate,  diet,  new  employments,  and  age  might  in- 
duce upon  the  fyftem.  I  am  difpofed  to  believe  that  many 
lives  are  loft,  and  numerous  chronic  difeafes  created  in  Great 
Britain  by  the  negleft  of  bleeding  in  fevers.  My  former  pupil 
I>r.  Fifher  in  a  letter  from  the  Univerfity  of  Edinburgh, 
dated  in  the  Winter  of  1795,  aflures  me  that  he  had  cured 
feveral  of  his  fellow  ftudents  of  fevers  (contrary  to  general 
prejudice)  by  early  bleeding,  in  as  eafy  and  fummary  a  way 
as  he  had  been  accuftomed  to  fee  them  cured  in  Philadelphia, 
by  the  ufe  of  the  fame  remedy.  Dr.  Gordon  of  Scotland, 
and  feveral  other  phyficians  in  Great  Britain  have  lately  re- 
vived the  lancet,  and  applied  it  with  great  judgment,  and 
f»5:cefs  to  the  cure  of  fevers. 

raster 


A    DEFENCE    OF    BLOOD-LETTING.  2^^ 

rafler  in  many  cafes  by  being  prefciibed  for  the  na?ne 
of  a  difeafe.  It  is  flill  ufed,  Mr.  Townfend  tells  us, 
in  this  empirical  way  in  Spain,  where  a  phyfician, 
when  fent  for  to  a  patient,  orders  him  to  be  bled 
before  he  vifits  him.  The  late  jull  theory  of  the 
manner  in  which  opium  ac^s  upon  the  body,  has  re- 
trained its  mifchief,  and  added  greatly  to  its  ufeful- 
nefs.  In  like  manner,  may  we  not  hope  that  jufl 
theories  of  difeafes,  and  proper  ideas  of  the  m.anner 
in  which  bleeding  a£ls  in  curing  them,  will  prevent 
a  relapfe  into  the  evils  which  formerly  accompanied 
tbis  remedy,  and  render  it  a  great  and  univerfal 
blefling  to  mankind  ? 

I  have  great  pleafure  in  acknowledging,  that  the 
eflablifliment  and  defence  of  blood-letting  has  not 
been  committed  to  me  alone,  in  the  city  of  Philadel- 
phia. A  number  of  our  phyficians,  highly  refpe£t- 
able  for  talents  and  knowledge,  have  adopted  this 
invaluable  remedy,  and  have  ufed  it  with  a  fuccefs 
which  has  rendered  their  pra6i:ice  reputable  to  them- 
felves,  and  beneficial  to  the  public.  The  fuperior 
fuccefs  of  the  friends  of  blood-letting  in  recovering- 
patients,  is  acknowledged  by  all  ranks  of  citizens ; 
but  they  have  been  taught  by  fomc  of  the  phyficians 
of  the  city  to  believe,  that  this  fuccefs  does  not  ex- 
tend to  malignant  and  dangerous  difeafes.  For  ex- 
ample.     Thefe  gentlemen   fay    the  yellow  fevers 

which 


254  ^   D£f£NC£    OF   BLOOD-LETTING- 

which  we  cure  by  copious  blood-letting  are  common 
remittents  or  intermittents ;  and  that  the  manias, 
the  internal  dropfies  of  the  brain,  and  the  pulmo- 
nary confumptions  which  we  prevent,  or  cure,  by 
the  fame  remedy,  are  either  tranfient  derangements 
of  mind  from  trifling  fevers,  or  common  head  achs, 
or  colds.  But  error  and  calumny  in  this,  as  in  many 
other  cafes,  refute  themfelves.  It  is  well  known 
that  all  thofe  difeafes  have  prevailed  for  feveral  years 
in  our  city,  and  that  moll  of  our  phyficians  have  had 
their  ufual  proportion  of  patients  in  them.  It  is 
fcarcely  poiTible  that  we  iliould  maintain  our  propor- 
tion of  bufmefs,  and  not  meet  with  the  fame  num- 
ber of  cafes  of  thofe  difeafes  as  our  brethren.  We 
do  meet  with  them,  and  we  prevent  their  mortality, 
in  a  great  degree,  by  copious  or  frequent  blood- 
letting. 

From  the  influence  which  this  detraiElion  from  the 
merit  of  bleeding  has  upon  its  fuceefs,  we  are  forced 
to  lament,  that  the  greateil  poflible  benefits  will 
never  be  derived  from  it,  until  the  fame  uniformity 
of  opinion  and  pra£i:ice  obtain  with  refpe6l  to  its  ufe, 
which  prevails  with  refpe^i:  to  the  ufe  of  pure  air  and 
cool  drinks  in  fevers. 

How  long  error,   ignorance,  prejudice,  and   in- 

terefl,  upon  the  fubje£l  of  blood-lettiug,  fhall  con- 

4  tinue 


A    DEFENCE    OF   BLOOD-LETTING.  2S5 

tinue  to  render  fevers  one  of  the  principal  outlets  of 
human  life,  I  know  not ;  but  their  influence  cannot 
laft  always.  Perhaps  the  bleiTmgs  of  fpeedy  health, 
long  life,  and  more  univerfal  population,  which  are 
infured  in  a  great  degree  by  the  ufe  of  this  re- 
medy, may  be  referved  by  heaven  for  a  more  vir- 
tuous and  enlightened  race  of  men,  than  thofe  who 
CQmpofe  the  prefent  inhabitants  of  our  globe. 

I  fliall  conclude  this  work  by  a  reflexion  which 
has  been  fuggefled  by  fome  of  the  preceding  pages. 

The  prefent  is  an  eventful  asra  in  human  affairs. 
Our  world  appears  to  be  upon  the  eve  of  a  great 
and  univerfal  revolution.  This  revolution,  I  be- 
lieve, will  ultimately  be  in  favour  of  human  happi- 
nefs.  I  do  not  found  my  belief  of  a  change  for  the 
better,  in  the  condition  of  mankind,  upon  the  pre- 
sent ftate  of  things  ;  for  every  view  we  can  take  of 
them,  whether  it  be  directed  to  morals,  religion,  or 
government,  exhibits  the  reverfe  of  fuch  a  change. 
I  believe  in  the  rapid  approach  of  a  new  order  of 
things,  from  the  coincidence  of  prefent  events  with 
the  prediflions  contained  in  the  Old  and  New  Tefta- 
ments.  Thefe  predictions  are  now  accomplifliing  by 
natural  means.  Events,  effential  to  each  other,  have 
lately  taken  place,  as  if  by  concert,  in  different  na- 
tions j  and  truths,  effential  to  thofe  events,  have 

hccn 


^^6  A    DEFENCE    OF    BLOOD-LETTINCJ. 

been  difcovered  or  revived  in  different  parts  of  the 
world.     Thus,  in  a  former  age,  the  difcovery  of  the 
art  of  printing  was  connected  with  the  revival  of 
letters,  and  a  change  in  the  moral  and  religious  ftate 
of  Europe.     Thus,  too,  the  application  of  the  load- 
ftone  to  the  purpofe  of  navigation,  immediately  pre- 
ceded  the    difcovery  and    fettlement  of  America. 
One  of  the  predi£lions  alluded  to  in  the  Old  Tefta- 
ment  is,  that  agriculture,  civilization,  peace,  and  juft 
government  fhall  be  introduced  into  the  eaflern  coun- 
tries, and  of  courfe,  that  an  immenfe  increafe  of  the 
human  fpecies  fhall  be  effected  by  their  influence,  in 
that  part  of  the  globe.     To  this  delightful  change 
in  the  ftate  of  the  eaflern  part  of  the  world,  there 
exifts  but  one  natural  obflacle;  and  that  is,    the 
plague  and  other  malignant  fevers  ftill  continue  to 
depopulate  whole  cities  and  nations,  thereby  often 
producing  every  fpecies  of  public  and  private  mifery. 
The  extent  of  this  mifery  may  eafily  be  conceived  of, 
by  the  recital  of  a  fmgle  and  recent  event.     In  the 
year  1773  one  of  thofe  malignant  fevers  deftroyed 
275,000  people  in  Baflbrah,  amounting  to  feven- 
eighths  of  the  inhabitants  of  that  city.     To  obviate 
the  objedlion  to  the  fulfilment  of  ancient  prophecy, 
from  the  prevalence  of  malignant  and  deftrudive 
fevers  in  the  eaft,  it  will  only  be  neceffary  to  attend 
to  what  has  been  faid  by  Dr.   Hartley,   upon  the 
propagation  of  Chriflianity  throughout  the  world  by 
I  natural 


A    DEFENCE    OF    BLOOD-LETTING.  257 

natural  means.  "  Mankind  .■  (fiiys  this  enlightened" 
philofopher  and  Chriilian)  feem  to  have  it  in  their 
power  to  obtain  fuch  quahfications  in  a  natural  way, 
as,  by  being  conferred  upon  the  Apollles  in  a  fuper- 
naLural  one,  were  the  principal  means  of  their  fuc- 
cefs  in  the  firil  propagation  of  the  Gofpel. 

^'  Thus,  as  the  Apoftles  had  the  power  of  heal- 
ing miracnioufly,  future  miiuonaries  may,  in  a  jfliort 
time,  accomplilli  themfelves  with  the  knowledge  of 
all  the  chief  practical  rules  of  medicine.  This  art  is 
wonderfully  fnnplified  of  late  years,  and  is  improving 
every  day  in  fmiplicity  and  efficacy.  And  it  may 
be  hoped,  that  a  few  theoretical  pofitions,  well  af- 
certained,  with  a  moderate  experience,  may  enable 
the  young  pradlitioner  to  proceed  to  a  confiderable 
variety  of  cafes  with  fafety  and  fuccefs."  * 

What  Dr.  Hartley  preconceived  with  refpe(51:  to 
difeafes  in  general,  has,  we  hope,  been  realized  with 
refped  to  malignant  fevers.  If  we  may  judge  from 
the  fuccefs  which  has  lately  attended  the  treatment 
of  one  of  them  in  the  cities  of  Baltimore  and  Phila- 
delphia, we  may  {2lMy  affert,  that  no  one  of  them 
is  incurable.  It  will  not  be  neceffary  to  fend  men, 
educated  in  colleges,  into  the  Afiatic  countries  to 

'-  Obfervations  on  Man,  Propofition  clxxxiii.  p.  378. 

cure 


258  A    DEFENCE    OF    BLOOD-LETTING. 

cure  their  peftilentlal  dlfeafes.  Men,  and  even  wo- 
men, may  be  employed  for  that  purpofe,  who  have 
not  perverted  their  reafon  by  a  fervile  attachment  to 
any  fyflem  of  medicine.  It  will  be  fiifficient  for  our 
milTionaries  to  know,  that  a  powerful  epidemic  chafes 
away,  or  mixes  with  all  other  difeafes,  to  be  ac- 
quainted with  the  different  ftates  of  the  pulfe,  to  be 
able  to  open  a  vein,  to  adminiffer  a  few  flrong  dofes 
of  purging  phyfic,  and  to  gratify  the  calls  of  nature 
in  their  patients  for  cold  water  and  cool  air. 

I  enjoy,  in  the  profpecl  of  thefe  events,  a  confo- 
lation  which  furpalTes,  beyond  calculation,  all  the 
diflrefs  and  pain  I  have  felt  from  my  unfuccefsful  at- 
tempts to  introduce  the  remedies  for  malignant 
fevers  into  general  ufe  among  the  citizens  of  Phila- 
delphia ;  for  the  men  who  are  to  live  an  hundred 
years  hence,  and  in  foreign  countries,  ihould  be  con- 
lldered  as  equally  fellow  citizens  with  thofe  who  are 
our  coevals,  and  who  live  and  die  in  the  fame  coun- 
try with  us. 


THE    END. 


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